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- <?xml version="1.0" encoding="UTF-8"?><PurcForm><Xform><xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:jr="http://openrosa.org/javarosa"><parsererror xmlns="http://www.w3.org/1999/xhtml" style="display: block; white-space: pre; border: 2px solid #c77; padding: 0 1em 0 1em; margin: 1em; background-color: #fdd; color: black"><h3>This page contains the following errors:</h3><div style="font-family:monospace;font-size:12px">error on line 5 at column 115: xmlns:openmrs: 'formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/8-1' is not a valid URI
- </div><h3>Below is a rendering of the page up to the first error.</h3></parsererror><parsererror xmlns="http://www.w3.org/1999/xhtml" style="display: block; white-space: pre; border: 2px solid #c77; padding: 0 1em 0 1em; margin: 1em; background-color: #fdd; color: black"><h3>This page contains the following errors:</h3><div style="font-family:monospace;font-size:12px">error on line 5 at column 217: xmlns:openmrs: 'formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/8-1' is not a valid URI
- </div><h3>Below is a rendering of the page up to the first error.</h3></parsererror>
- <xf:model id="openmrs_model">
- <xf:instance id="openmrs_model_instance">
- <form xmlns:openmrs="formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/8-1" xmlns:xd="http://schemas.microsoft.com/office/infopath/2003" id="8" name="Kivulini Patient Registration" version="1.0" uuid="0d0d712f-6505-4b78-84d1-d971aeb8b026">
- <header>
- <enterer/>
- <date_entered/>
- <session/>
- <uid/>
- </header>
- <patient>
- <patient.birthdate openmrs_table="patient" openmrs_attribute="birthdate"/>
- <patient.family_name openmrs_table="person_name" openmrs_attribute="family_name"/>
- <patient.given_name openmrs_table="person_name" openmrs_attribute="given_name"/>
- <patient.medical_record_number openmrs_table="patient_identifier" openmrs_attribute="identifier"/>
- <patient.middle_name openmrs_table="person_name" openmrs_attribute="middle_name"/>
- <patient.mobile.phone openmrs_concept="163141^PATIENT.MOBILE.PHONE^99DCT" openmrs_datatype="ST">
- <date xsi:nil="true"/>
- <time xsi:nil="true"/>
- <value xsi:nil="true"/>
- </patient.mobile.phone>
- <patient.nok openmrs_concept="163142^PATIENT.NOK^99DCT" openmrs_datatype="ST">
- <nok.surname openmrs_concept="163143^NOK.SURNAME^99DCT" openmrs_datatype="ST">
- <date xsi:nil="true"/>
- <time xsi:nil="true"/>
- <value xsi:nil="true"/>
- </nok.surname>
- <nok.other.name openmrs_concept="163144^NOK.OTHER.NAME^99DCT" openmrs_datatype="ST">
- <date xsi:nil="true"/>
- <time xsi:nil="true"/>
- <value xsi:nil="true"/>
- </nok.other.name>
- <nok.relationship openmrs_concept="163145^NOK.RELATIONSHIP^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true"/>
- <time xsi:nil="true"/>
- <value xsi:nil="true"/>
- </nok.relationship>
- <nok.phone.number openmrs_concept="163146^NOK.PHONE.NUMBER^99DCT" openmrs_datatype="ST">
- <date xsi:nil="true"/>
- <time xsi:nil="true"/>
- <value xsi:nil="true"/>
- </nok.phone.number>
- </patient.nok>
- <patient.patient_id openmrs_table="patient" openmrs_attribute="patient_id"/>
- <patient.sex openmrs_table="patient" openmrs_attribute="gender"/>
- <patient_relative>
- <patient_relative.person/>
- <patient_relative.relationship/>
- </patient_relative>
- </patient>
- <encounter>
- <encounter.encounter_datetime openmrs_table="encounter" openmrs_attribute="encounter_datetime">'today()'</encounter.encounter_datetime>
- <encounter.location_id openmrs_table="encounter" openmrs_attribute="location_id"/>
- <encounter.provider_id openmrs_table="encounter" openmrs_attribute="provider_id" provider_id_type="PROVIDER.ID"/>
- </encounter>
- </form>
- </xf:instance>
- <xf:bind id="patient.birthdate" nodeset="/form/patient/patient.birthdate" type="xsd:date" locked="true()" jr:preload="patient" jr:preloadParams="birthDate"/>
- <xf:bind id="patient.family_name" nodeset="/form/patient/patient.family_name" type="xsd:string" locked="true()" jr:preload="patient" jr:preloadParams="familyName"/>
- <xf:bind id="patient.given_name" nodeset="/form/patient/patient.given_name" type="xsd:string" locked="true()" jr:preload="patient" jr:preloadParams="givenName"/>
- <xf:bind id="patient.medical_record_number" nodeset="/form/patient/patient.medical_record_number" type="xsd:string" locked="true()" jr:preload="patient" jr:preloadParams="patientIdentifier"/>
- <xf:bind id="patient.middle_name" nodeset="/form/patient/patient.middle_name" type="xsd:string" locked="true()" jr:preload="patient" jr:preloadParams="middleName"/>
- <xf:bind id="patient.mobile.phone" nodeset="/form/patient/patient.mobile.phone/value" type="xsd:string"/>
- <xf:bind id="patient.nok" nodeset="/form/patient/patient.nok"/>
- <xf:bind id="nok.surname" nodeset="/form/patient/patient.nok/nok.surname/value" type="xsd:string"/>
- <xf:bind id="nok.other.name" nodeset="/form/patient/patient.nok/nok.other.name/value" type="xsd:string"/>
- <xf:bind id="nok.relationship" nodeset="/form/patient/patient.nok/nok.relationship/value" type="xsd:string"/>
- <xf:bind id="nok.phone.number" nodeset="/form/patient/patient.nok/nok.phone.number/value" type="xsd:string"/>
- <xf:bind id="patient.patient_id" nodeset="/form/patient/patient.patient_id" type="xsd:int" required="true()" visible="false()" jr:preload="patient" jr:preloadParams="patientId"/>
- <xf:bind id="patient.sex" nodeset="/form/patient/patient.sex" type="xsd:string" locked="true()" jr:preload="patient" jr:preloadParams="sex"/>
- <xf:bind id="encounter.encounter_datetime" nodeset="/form/encounter/encounter.encounter_datetime" type="xsd:date" constraint=". <= today()" message="Encounter date cannot be after today" required="true()"/>
- <xf:bind id="encounter.location_id" nodeset="/form/encounter/encounter.location_id" type="xsd:string" required="true()"/>
- <xf:bind id="encounter.provider_id" nodeset="/form/encounter/encounter.provider_id" type="xsd:string" required="true()"/>
- <xf:bind id="patient_relative" nodeset="/form/patient/patient_relative" visible="false()"/>
- <xf:bind id="patient_relative.person" nodeset="/form/patient/patient_relative/patient_relative.person" type="xsd:string"/>
- <xf:bind id="patient_relative.relationship" nodeset="/form/patient/patient_relative/patient_relative.relationship" type="xsd:string"/>
- </xf:model>
- <xf:group id="1">
- <xf:label>Page1</xf:label>
- <xf:input bind="patient.birthdate">
- <xf:label>DoB</xf:label>
- </xf:input>
- <xf:input bind="patient.family_name">
- <xf:label>FAMILY NAME</xf:label>
- </xf:input>
- <xf:input bind="patient.given_name">
- <xf:label>GIVEN NAME</xf:label>
- </xf:input>
- <xf:input bind="patient.medical_record_number">
- <xf:label>MEDICAL RECORD NUMBER</xf:label>
- </xf:input>
- <xf:input bind="patient.middle_name">
- <xf:label>MIDDLE NAME</xf:label>
- </xf:input>
- <xf:input bind="patient.patient_id">
- <xf:label>PATIENT ID</xf:label>
- </xf:input>
- <xf:input bind="patient.sex">
- <xf:label>SEX</xf:label>
- </xf:input>
- <xf:input bind="encounter.encounter_datetime">
- <xf:label>ENCOUNTER DATETIME</xf:label>
- </xf:input>
- <xf:select1 bind="encounter.location_id">
- <xf:label>LOCATION ID</xf:label>
- <xf:item id="8">
- <xf:label>Amani Hospital [8]</xf:label>
- <xf:value>8</xf:value>
- </xf:item>
- <xf:item id="6">
- <xf:label>Inpatient Ward [6]</xf:label>
- <xf:value>6</xf:value>
- </xf:item>
- <xf:item id="4">
- <xf:label>Isolation Ward [4]</xf:label>
- <xf:value>4</xf:value>
- </xf:item>
- <xf:item id="3">
- <xf:label>Laboratory [3]</xf:label>
- <xf:value>3</xf:value>
- </xf:item>
- <xf:item id="7">
- <xf:label>Outpatient Clinic [7]</xf:label>
- <xf:value>7</xf:value>
- </xf:item>
- <xf:item id="2">
- <xf:label>Pharmacy [2]</xf:label>
- <xf:value>2</xf:value>
- </xf:item>
- <xf:item id="5">
- <xf:label>Registration Desk [5]</xf:label>
- <xf:value>5</xf:value>
- </xf:item>
- <xf:item id="1">
- <xf:label>Unknown Location [1]</xf:label>
- <xf:value>1</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="encounter.provider_id">
- <xf:label>PROVIDER ID</xf:label>
- <xf:item id="3">
- <xf:label>Super User [UNKNOWN]</xf:label>
- <xf:value>3</xf:value>
- </xf:item>
- <xf:item id="4">
- <xf:label>John Smith [clerk]</xf:label>
- <xf:value>4</xf:value>
- </xf:item>
- <xf:item id="5">
- <xf:label>Jane Smith [nurse]</xf:label>
- <xf:value>5</xf:value>
- </xf:item>
- <xf:item id="6">
- <xf:label>Jake Smith [doctor]</xf:label>
- <xf:value>6</xf:value>
- </xf:item>
- <xf:item id="1">
- <xf:label>null [100-1]</xf:label>
- <xf:value>1</xf:value>
- </xf:item>
- <xf:item id="2">
- <xf:label>null [100-2]</xf:label>
- <xf:value>2</xf:value>
- </xf:item>
- </xf:select1>
- <xf:input bind="patient.mobile.phone">
- <xf:label>PATIENT.MOBILE.PHONE</xf:label>
- <xf:hint>Mobile phone number in Tanzania</xf:hint>
- </xf:input>
- <xf:input bind="patient.nok">
- <xf:label>PATIENT.NOK</xf:label>
- <xf:hint>Patients next of kin</xf:hint>
- </xf:input>
- <xf:group id="patient.nok">
- <xf:label>PATIENT.NOK</xf:label>
- <xf:hint>Patients next of kin</xf:hint>
- <xf:input bind="nok.surname">
- <xf:label>NOK.SURNAME</xf:label>
- <xf:hint>Surname of Next of Kin</xf:hint>
- </xf:input>
- <xf:input bind="nok.other.name">
- <xf:label>NOK.OTHER.NAME</xf:label>
- </xf:input>
- <xf:select1 bind="nok.relationship">
- <xf:label>NOK.RELATIONSHIP</xf:label>
- <xf:item concept_id="163145" id="163147^RELATIONSHIP.SPOUSE^99DCT">
- <xf:label>RELATIONSHIP.SPOUSE</xf:label>
- <xf:value>163147^RELATIONSHIP.SPOUSE^99DCT</xf:value>
- </xf:item>
- <xf:item concept_id="163145" id="163148^RELATIONSHIP.PARENT^99DCT">
- <xf:label>RELATIONSHIP.PARENT</xf:label>
- <xf:value>163148^RELATIONSHIP.PARENT^99DCT</xf:value>
- </xf:item>
- <xf:item concept_id="163145" id="163149^RELATIONSHIP.BROTHER^99DCT">
- <xf:label>RELATIONSHIP.BROTHER</xf:label>
- <xf:value>163149^RELATIONSHIP.BROTHER^99DCT</xf:value>
- </xf:item>
- <xf:item concept_id="163145" id="163150^RELATIONSHIP.SISTER^99DCT">
- <xf:label>RELATIONSHIP.SISTER</xf:label>
- <xf:value>163150^RELATIONSHIP.SISTER^99DCT</xf:value>
- </xf:item>
- <xf:item concept_id="163145" id="163151^RELATIONSHIP.CHILD^99DCT">
- <xf:label>RELATIONSHIP.CHILD</xf:label>
- <xf:value>163151^RELATIONSHIP.CHILD^99DCT</xf:value>
- </xf:item>
- <xf:item concept_id="163145" id="163152^RELATIONSHIP.OTHER^99DCT">
- <xf:label>RELATIONSHIP.OTHER</xf:label>
- <xf:value>163152^RELATIONSHIP.OTHER^99DCT</xf:value>
- </xf:item>
- </xf:select1>
- <xf:input bind="nok.phone.number">
- <xf:label>NOK.PHONE.NUMBER</xf:label>
- </xf:input>
- </xf:group>
- <xf:group id="patient/patient_relative">
- <xf:label>RELATIONSHIPS</xf:label>
- <xf:hint>Relationships that this patient has.</xf:hint>
- <xf:repeat bind="patient_relative">
- <xf:input bind="patient_relative.person">
- <xf:label>RELATIVE</xf:label>
- </xf:input>
- <xf:select1 bind="patient_relative.relationship">
- <xf:item id="1A">
- <xf:label>is Doctor [1]</xf:label>
- <xf:value>1A</xf:value>
- </xf:item>
- <xf:item id="1B">
- <xf:label>is Patient [1]</xf:label>
- <xf:value>1B</xf:value>
- </xf:item>
- <xf:item id="2A">
- <xf:label>is Sibling [2]</xf:label>
- <xf:value>2A</xf:value>
- </xf:item>
- <xf:item id="3A">
- <xf:label>is Parent [3]</xf:label>
- <xf:value>3A</xf:value>
- </xf:item>
- <xf:item id="3B">
- <xf:label>is Child [3]</xf:label>
- <xf:value>3B</xf:value>
- </xf:item>
- <xf:item id="4A">
- <xf:label>is Aunt/Uncle [4]</xf:label>
- <xf:value>4A</xf:value>
- </xf:item>
- <xf:item id="4B">
- <xf:label>is Niece/Nephew [4]</xf:label>
- <xf:value>4B</xf:value>
- </xf:item>
- <xf:item id="5A">
- <xf:label>is Supervisor [5]</xf:label>
- <xf:value>5A</xf:value>
- </xf:item>
- <xf:item id="5B">
- <xf:label>is Supervisee [5]</xf:label>
- <xf:value>5B</xf:value>
- </xf:item>
- <xf:label>RELATIONSHIP</xf:label>
- </xf:select1>
- </xf:repeat>
- </xf:group>
- </xf:group>
- </xf:xforms></Xform><Layout><Form id="8"><Page Text="Page1" fontWeight="normal" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, Sans-Serif" Binding="Page1" Width="900px" Height="965px" backgroundColor=""><Item WidgetType="Label" Text="BIRTHDATE" HelpText="BIRTHDATE" Binding="patient/patient.birthdate" Left="150px" Top="20px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="DatePicker" HelpText="BIRTHDATE" Binding="patient/patient.birthdate" Left="248px" Top="20px" Width="200px" Height="25px" TabIndex="1" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="FAMILY NAME" HelpText="FAMILY NAME" Binding="patient/patient.family_name" Left="133px" Top="60px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="FAMILY NAME" Binding="patient/patient.family_name" Left="248px" Top="60px" Width="200px" Height="25px" TabIndex="2" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="GIVEN NAME" HelpText="GIVEN NAME" Binding="patient/patient.given_name" Left="138px" Top="100px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="GIVEN NAME" Binding="patient/patient.given_name" Left="248px" Top="100px" Width="200px" Height="25px" TabIndex="3" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="MEDICAL RECORD NUMBER" HelpText="MEDICAL RECORD NUMBER" Binding="patient/patient.medical_record_number" Left="20px" Top="140px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="MEDICAL RECORD NUMBER" Binding="patient/patient.medical_record_number" Left="248px" Top="140px" Width="200px" Height="25px" TabIndex="4" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="MIDDLE NAME" HelpText="MIDDLE NAME" Binding="patient/patient.middle_name" Left="126px" Top="180px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="MIDDLE NAME" Binding="patient/patient.middle_name" Left="248px" Top="180px" Width="200px" Height="25px" TabIndex="5" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="PATIENT.MOBILE.PHONE" HelpText="Mobile phone number in Tanzania" Binding="patient/patient.mobile.phone/value" Left="46px" Top="220px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Mobile phone number in Tanzania" Binding="patient/patient.mobile.phone/value" Left="248px" Top="220px" Width="200px" Height="25px" TabIndex="6" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="GroupBox" HelpText="Patients next of kin" Binding="patient/patient.nok" Left="20px" Top="260px" Width="500px" Height="170px" TabIndex="7" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" borderStyle="dashed" borderWidth="1px" borderColor="rgb(143, 171, 199)"><Item WidgetType="Label" Text="PATIENT.NOK" HelpText="Patients next of kin" Binding="patient/patient.nok" Left="0px" Top="0px" Width="100%" Height="20px" TabIndex="0" color="white" fontWeight="bold" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="rgb(143, 171, 199)" textAlign="center" HeaderLabel="true"/><Item WidgetType="Label" Text="NOK.SURNAME" HelpText="Surname of Next of Kin" Binding="patient/patient.nok/nok.surname/value" Left="62px" Top="30px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Surname of Next of Kin" Binding="patient/patient.nok/nok.surname/value" Left="189px" Top="30px" Width="200px" Height="25px" TabIndex="1" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="NOK.OTHER.NAME" HelpText="NOK.OTHER.NAME" Binding="patient/patient.nok/nok.other.name/value" Left="34px" Top="65px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NOK.OTHER.NAME" Binding="patient/patient.nok/nok.other.name/value" Left="189px" Top="65px" Width="200px" Height="25px" TabIndex="2" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="NOK.RELATIONSHIP" HelpText="NOK.RELATIONSHIP" Binding="patient/patient.nok/nok.relationship/value" Left="21px" Top="100px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="NOK.RELATIONSHIP" Binding="patient/patient.nok/nok.relationship/value" Left="189px" Top="100px" Width="200px" Height="25px" TabIndex="3" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="NOK.PHONE.NUMBER" HelpText="NOK.PHONE.NUMBER" Binding="patient/patient.nok/nok.phone.number/value" Left="10px" Top="135px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NOK.PHONE.NUMBER" Binding="patient/patient.nok/nok.phone.number/value" Left="189px" Top="135px" Width="200px" Height="25px" TabIndex="4" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/></Item><Item WidgetType="Label" Text="SEX" HelpText="SEX" Binding="patient/patient.sex" Left="210px" Top="450px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="SEX" Binding="patient/patient.sex" Left="248px" Top="450px" Width="200px" Height="25px" TabIndex="8" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="ENCOUNTER DATETIME" HelpText="ENCOUNTER DATETIME" Binding="encounter/encounter.encounter_datetime" Left="54px" Top="490px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="DatePicker" HelpText="ENCOUNTER DATETIME" Binding="encounter/encounter.encounter_datetime" Left="248px" Top="490px" Width="200px" Height="25px" TabIndex="9" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="LOCATION ID" HelpText="LOCATION ID" Binding="encounter/encounter.location_id" Left="134px" Top="530px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="LOCATION ID" Binding="encounter/encounter.location_id" Left="248px" Top="530px" Width="200px" Height="25px" TabIndex="10" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="PROVIDER ID" HelpText="PROVIDER ID" Binding="encounter/encounter.provider_id" Left="133px" Top="570px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="PROVIDER ID" Binding="encounter/encounter.provider_id" Left="248px" Top="570px" Width="200px" Height="25px" TabIndex="11" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="RELATIONSHIPS" HelpText="Relationships that this patient has." Binding="patient/patient_relative" Left="20px" Top="610px" TabIndex="0" fontWeight="bold" fontStyle="italic" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="RELATIVE" HelpText="RELATIVE" Binding="patient/patient_relative/patient_relative.person" Left="35px" Top="635px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" textDecoration="underline"/><Item WidgetType="Label" Text="RELATIONSHIP" HelpText="RELATIONSHIP" Binding="patient/patient_relative/patient_relative.relationship" Left="245px" Top="635px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" textDecoration="underline"/><Item WidgetType="GroupBox" HelpText="Relationships that this patient has." Binding="patient/patient_relative" Left="20px" Top="660px" Width="425px" Height="100px" TabIndex="12" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" borderWidth="1px" borderColor="rgb(143, 171, 199)" Repeated="1"><Item WidgetType="Button" Text="Add New" HelpText="addnew" Binding="addnew" Left="10px" Top="55px" Width="70px" Height="30px" TabIndex="0" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="RELATIVE" Binding="patient/patient_relative/patient_relative.person" Left="10px" Top="10px" Width="200px" Height="25px" TabIndex="1" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="RELATIONSHIP" Binding="patient/patient_relative/patient_relative.relationship" Left="215px" Top="10px" Width="200px" Height="25px" TabIndex="2" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/></Item><Item WidgetType="Button" Text="Submit" HelpText="submit" Binding="submit" Left="20px" Top="800px" Width="70px" Height="30px" TabIndex="13" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Button" Text="Close" HelpText="cancel" Binding="cancel" Left="220px" Top="800px" Width="70px" Height="30px" TabIndex="14" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/></Page></Form></Layout><Language><LanguageText lang="en"><xform id="8"><text xpath="xforms/model[@id='openmrs_model']/instance[@id='openmrs_model_instance']/form[@name]" value="Kivulini Patient Registration"/><text xpath="xforms/group[@id='1']/label" value="Page1"/><text xpath="xforms/group[@id='1']/input[@bind='patient.birthdate']/label" value="DoB"/><text xpath="xforms/group[@id='1']/input[@bind='patient.family_name']/label" value="FAMILY NAME"/><text xpath="xforms/group[@id='1']/input[@bind='patient.given_name']/label" value="GIVEN NAME"/><text xpath="xforms/group[@id='1']/input[@bind='patient.medical_record_number']/label" value="MEDICAL RECORD NUMBER"/><text xpath="xforms/group[@id='1']/input[@bind='patient.middle_name']/label" value="MIDDLE NAME"/><text xpath="xforms/group[@id='1']/input[@bind='patient.mobile.phone']/label" value="PATIENT.MOBILE.PHONE"/><text xpath="xforms/group[@id='1']/input[@bind='patient.mobile.phone']/hint" value="Mobile phone number in Tanzania"/><text xpath="xforms/group[@id='1']/xforms/group[@id='1']/label" value="PATIENT.NOK"/><text xpath="xforms/group[@id='1']/xforms/group[@id='1']/hint" value="Patients next of kin"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/input[@bind='nok.surname']/label" value="NOK.SURNAME"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/input[@bind='nok.surname']/hint" value="Surname of Next of Kin"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/input[@bind='nok.other.name']/label" value="NOK.OTHER.NAME"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/select1[@bind='nok.relationship']/label" value="NOK.RELATIONSHIP"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/select1[@bind='nok.relationship']/item[@id='163147^RELATIONSHIP.SPOUSE^99DCT']/label" value="RELATIONSHIP.SPOUSE"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/select1[@bind='nok.relationship']/item[@id='163148^RELATIONSHIP.PARENT^99DCT']/label" value="RELATIONSHIP.PARENT"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/select1[@bind='nok.relationship']/item[@id='163149^RELATIONSHIP.BROTHER^99DCT']/label" value="RELATIONSHIP.BROTHER"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/select1[@bind='nok.relationship']/item[@id='163150^RELATIONSHIP.SISTER^99DCT']/label" value="RELATIONSHIP.SISTER"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/select1[@bind='nok.relationship']/item[@id='163151^RELATIONSHIP.CHILD^99DCT']/label" value="RELATIONSHIP.CHILD"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/select1[@bind='nok.relationship']/item[@id='163152^RELATIONSHIP.OTHER^99DCT']/label" value="RELATIONSHIP.OTHER"/><text xpath="xforms/group[@id='1']/group[@id='patient.nok']/input[@bind='nok.phone.number']/label" value="NOK.PHONE.NUMBER"/><text xpath="xforms/group[@id='1']/input[@bind='patient.patient_id']/label" value="PATIENT ID"/><text xpath="xforms/group[@id='1']/input[@bind='patient.sex']/label" value="SEX"/><text xpath="xforms/group[@id='1']/input[@bind='encounter.encounter_datetime']/label" value="ENCOUNTER DATETIME"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/label" value="LOCATION ID"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='8']/label" value="Amani Hospital [8]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='6']/label" value="Inpatient Ward [6]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='4']/label" value="Isolation Ward [4]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='3']/label" value="Laboratory [3]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='7']/label" value="Outpatient Clinic [7]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='2']/label" value="Pharmacy [2]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='5']/label" value="Registration Desk [5]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.location_id']/item[@id='1']/label" value="Unknown Location [1]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/label" value="PROVIDER ID"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='3']/label" value="Super User [UNKNOWN]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='4']/label" value="John Smith [clerk]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='5']/label" value="Jane Smith [nurse]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='6']/label" value="Jake Smith [doctor]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='1']/label" value="null [100-1]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='2']/label" value="null [100-2]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/label" value="RELATIONSHIPS"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/hint" value="Relationships that this patient has."/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/input[@bind='patient_relative.person']/label" value="RELATIVE"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/label" value="RELATIONSHIP"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='1A']/label" value="is Doctor [1]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='1B']/label" value="is Patient [1]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='2A']/label" value="is Sibling [2]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='3A']/label" value="is Parent [3]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='3B']/label" value="is Child [3]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='4A']/label" value="is Aunt/Uncle [4]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='4B']/label" value="is Niece/Nephew [4]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='5A']/label" value="is Supervisor [5]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='5B']/label" value="is Supervisee [5]"/><text xpath="xforms/model[@id='openmrs_model']/bind[@id='encounter.encounter_datetime'][@message]" value="Encounter date cannot be after today"/></xform><Form id="8"><text xpath="Form/Page[@Binding='Page1'][@Text]" value="Page1"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='Label'][@Text]" value="BIRTHDATE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='Label'][@HelpText]" value="BIRTHDATE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='Label'][@Top]" value="20px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='Label'][@Left]" value="150px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='DatePicker'][@HelpText]" value="BIRTHDATE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='DatePicker'][@Top]" value="20px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='DatePicker'][@Left]" value="248px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.birthdate' and @WidgetType='DatePicker'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='Label'][@Text]" value="FAMILY NAME"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='Label'][@HelpText]" value="FAMILY NAME"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='Label'][@Top]" value="60px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='Label'][@Left]" value="133px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='TextBox'][@HelpText]" value="FAMILY NAME"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='TextBox'][@Top]" value="60px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='TextBox'][@Left]" value="248px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.family_name' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.given_name' and @WidgetType='Label'][@Text]" value="GIVEN NAME"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.given_name' and @WidgetType='Label'][@HelpText]" value="GIVEN NAME"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.given_name' and @WidgetType='Label'][@Top]" value="100px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.given_name' and @WidgetType='Label'][@Left]" value="138px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient/patient.given_name' and @WidgetType='TextBox'][@HelpText]" value="GIVEN NAME"/><text 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