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  1. <?xml version="1.0" encoding="UTF-8"?>
  2. <xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" xmlns:jr="http://openrosa.org/javarosa" 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">
  3. <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">
  4. <h3>This page contains the following errors:</h3>
  5. <div style="font-family:monospace;font-size:12px">error on line 50 at column 44: xmlns:openmrs: 'formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/5-1' is not a valid URI </div>
  6. <h3>Below is a rendering of the page up to the first error.</h3>
  7. </parsererror>
  8. <xf:model>
  9. <xf:instance>
  10. <patient name="Patient" id="0" description-template="${/patient/family_name}$ ${/patient/middle_name}$ ${/patient/given_name}$">
  11. <enterer/>
  12. <family_name/>
  13. <middle_name/>
  14. <given_name/>
  15. <birth_date/>
  16. <birth_date_estimated/>
  17. <gender/>
  18. <degree/>
  19. <family_name2/>
  20. <family_name_prefix/>
  21. <family_name_suffix/>
  22. <prefix/>
  23. <location_id/>
  24. <patient_identifier_type_id/>
  25. <person_attribute2/>
  26. <person_attribute3/>
  27. <person_attribute5/>
  28. <person_attribute7/>
  29. <person_attribute6/>
  30. <person_attribute4/>
  31. <person_attribute1/>
  32. <person_attribute8/>
  33. <person_address_address1/>
  34. <person_address_address2/>
  35. <person_address_city_village/>
  36. <person_address_state_province/>
  37. <person_address_postal_code/>
  38. <person_address_country/>
  39. <person_address_latitude/>
  40. <person_address_longitude/>
  41. <person_address_county_district/>
  42. <person_address_neighborhood_cell/>
  43. <person_address_region/>
  44. <person_address_subregion/>
  45. <person_address_township_division/>
  46. <other_identifiers>
  47. <other_identifier/>
  48. <other_identifier_type_id/>
  49. <other_identifier_location_id/>
  50. </other_identifiers>
  51. <person_attribute9/>
  52. <person_attribute10/>
  53. <identifier/>
  54. <patient_id/>
  55. <form xmlns:openmrs="formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/5-1" xmlns:xd="http://schemas.microsoft.com/office/infopath/2003" id="5" name="Registration Encounter Form" version="0.1">
  56. <header>
  57. <enterer/>
  58. <date_entered/>
  59. <session/>
  60. <uid/>
  61. </header>
  62. <encounter>
  63. <encounter.encounter_datetime openmrs_table="encounter" openmrs_attribute="encounter_datetime">'today()'</encounter.encounter_datetime>
  64. <encounter.location_id openmrs_table="encounter" openmrs_attribute="location_id"/>
  65. <encounter.provider_id openmrs_table="encounter" openmrs_attribute="provider_id" provider_id_type="PROVIDER.ID"/>
  66. </encounter>
  67. <other/>
  68. </form>
  69. </patient>
  70. </xf:instance>
  71. <xf:bind id="family_name" nodeset="/patient/family_name" type="xsd:string" required="true()"/>
  72. <xf:bind id="middle_name" nodeset="/patient/middle_name" type="xsd:string"/>
  73. <xf:bind id="given_name" nodeset="/patient/given_name" type="xsd:string"/>
  74. <xf:bind id="birth_date" nodeset="/patient/birth_date" type="xsd:date"/>
  75. <xf:bind id="birth_date_estimated" nodeset="/patient/birth_date_estimated" type="xsd:boolean"/>
  76. <xf:bind id="gender" nodeset="/patient/gender" type="xsd:string"/>
  77. <xf:bind id="degree" nodeset="/patient/degree" type="xsd:string"/>
  78. <xf:bind id="family_name2" nodeset="/patient/family_name2" type="xsd:string"/>
  79. <xf:bind id="family_name_prefix" nodeset="/patient/family_name_prefix" type="xsd:string"/>
  80. <xf:bind id="family_name_suffix" nodeset="/patient/family_name_suffix" type="xsd:string"/>
  81. <xf:bind id="prefix" nodeset="/patient/prefix" type="xsd:string"/>
  82. <xf:bind id="location_id" nodeset="/patient/location_id" type="xsd:string" required="true()"/>
  83. <xf:bind id="patient_identifier_type_id" nodeset="/patient/patient_identifier_type_id" type="xsd:string" required="true()"/>
  84. <xf:bind id="person_attribute2" nodeset="/patient/person_attribute2" type="xsd:string"/>
  85. <xf:bind id="person_attribute3" nodeset="/patient/person_attribute3" type="xsd:string"/>
  86. <xf:bind id="person_attribute5" nodeset="/patient/person_attribute5" type="xsd:string"/>
  87. <xf:bind id="person_attribute7" nodeset="/patient/person_attribute7" type="xsd:string"/>
  88. <xf:bind id="person_attribute6" nodeset="/patient/person_attribute6" type="xsd:string"/>
  89. <xf:bind id="person_attribute4" nodeset="/patient/person_attribute4" type="xsd:string"/>
  90. <xf:bind id="person_attribute1" nodeset="/patient/person_attribute1" type="xsd:string"/>
  91. <xf:bind id="person_attribute8" nodeset="/patient/person_attribute8" type="xsd:string"/>
  92. <xf:bind id="person_address_address1" nodeset="/patient/person_address_address1" type="xsd:string"/>
  93. <xf:bind id="person_address_address2" nodeset="/patient/person_address_address2" type="xsd:string"/>
  94. <xf:bind id="person_address_city_village" nodeset="/patient/person_address_city_village" type="xsd:string"/>
  95. <xf:bind id="person_address_state_province" nodeset="/patient/person_address_state_province" type="xsd:string"/>
  96. <xf:bind id="person_address_postal_code" nodeset="/patient/person_address_postal_code" type="xsd:string"/>
  97. <xf:bind id="person_address_country" nodeset="/patient/person_address_country" type="xsd:string"/>
  98. <xf:bind id="person_address_latitude" nodeset="/patient/person_address_latitude" type="xsd:string"/>
  99. <xf:bind id="person_address_longitude" nodeset="/patient/person_address_longitude" type="xsd:string"/>
  100. <xf:bind id="person_address_county_district" nodeset="/patient/person_address_county_district" type="xsd:string"/>
  101. <xf:bind id="person_address_neighborhood_cell" nodeset="/patient/person_address_neighborhood_cell" type="xsd:string"/>
  102. <xf:bind id="person_address_region" nodeset="/patient/person_address_region" type="xsd:string"/>
  103. <xf:bind id="person_address_subregion" nodeset="/patient/person_address_subregion" type="xsd:string"/>
  104. <xf:bind id="person_address_township_division" nodeset="/patient/person_address_township_division" type="xsd:string"/>
  105. <xf:bind id="other_identifiers" nodeset="/patient/other_identifiers" type="xsd:string"/>
  106. <xf:bind id="person_attribute9" nodeset="/patient/person_attribute9" type="xsd:string"/>
  107. <xf:bind id="person_attribute10" nodeset="/patient/person_attribute10" type="xsd:string"/>
  108. <xf:bind id="encounter.encounter_datetime" nodeset="/patient/form/encounter/encounter.encounter_datetime" type="xsd:dateTime" constraint=". &lt;= today()" message="Encounter date cannot be after today" required="true()"/>
  109. <xf:bind id="encounter.provider_id" nodeset="/patient/form/encounter/encounter.provider_id" type="xsd:string" required="true()"/>
  110. <xf:bind id="identifier" nodeset="/patient/identifier" type="xsd:string" required="true()"/>
  111. <xf:bind id="patient_id" nodeset="/patient/patient_id" type="xsd:int" readonly="true()" visible="false()"/>
  112. <xf:bind id="other_identifier" nodeset="/patient/other_identifiers/other_identifier" type="xsd:string"/>
  113. <xf:bind id="other_identifier_type_id" nodeset="/patient/other_identifiers/other_identifier_type_id" type="xsd:string"/>
  114. <xf:bind id="other_identifier_location_id" nodeset="/patient/other_identifiers/other_identifier_location_id" type="xsd:string"/>
  115. <xf:bind id="encounter.location_id" nodeset="/patient/form/encounter/encounter.location_id" type="xsd:int" required="true()"/>
  116. </xf:model>
  117. <xf:group id="1">
  118. <xf:label>Page1</xf:label>
  119. <xf:input bind="family_name">
  120. <xf:label>Family Name</xf:label>
  121. <xf:hint>The patient family name</xf:hint>
  122. </xf:input>
  123. <xf:input bind="middle_name">
  124. <xf:label>Middle Name</xf:label>
  125. <xf:hint>The patient middle name</xf:hint>
  126. </xf:input>
  127. <xf:input bind="given_name">
  128. <xf:label>Given Name</xf:label>
  129. <xf:hint>The patient given name</xf:hint>
  130. </xf:input>
  131. <xf:input bind="birth_date">
  132. <xf:label>Birth Date</xf:label>
  133. <xf:hint>The patient birth date</xf:hint>
  134. </xf:input>
  135. <xf:input bind="birth_date_estimated">
  136. <xf:label>Birth Date Estimated</xf:label>
  137. <xf:hint>Is the patient birth date estimated?</xf:hint>
  138. </xf:input>
  139. <xf:select1 bind="gender">
  140. <xf:label>Gender</xf:label>
  141. <xf:hint>The patient's sex</xf:hint>
  142. <xf:item id="M">
  143. <xf:label>Male</xf:label>
  144. <xf:value>M</xf:value>
  145. </xf:item>
  146. <xf:item id="F">
  147. <xf:label>Female</xf:label>
  148. <xf:value>F</xf:value>
  149. </xf:item>
  150. </xf:select1>
  151. <xf:input bind="degree">
  152. <xf:label>Degree</xf:label>
  153. <xf:hint>The patient name degree</xf:hint>
  154. </xf:input>
  155. <xf:input bind="family_name2">
  156. <xf:label>Family Name 2</xf:label>
  157. <xf:hint>The patient second family name</xf:hint>
  158. </xf:input>
  159. <xf:input bind="family_name_prefix">
  160. <xf:label>Family Name Prefix</xf:label>
  161. <xf:hint>The patient family name prefix</xf:hint>
  162. </xf:input>
  163. <xf:input bind="family_name_suffix">
  164. <xf:label>Family Name Suffix</xf:label>
  165. <xf:hint>The patient family name suffix</xf:hint>
  166. </xf:input>
  167. <xf:input bind="prefix">
  168. <xf:label>Prefix</xf:label>
  169. <xf:hint>The patient name prefix</xf:hint>
  170. </xf:input>
  171. <xf:select1 bind="location_id">
  172. <xf:label>Location</xf:label>
  173. <xf:hint>The patient's location</xf:hint>
  174. <xf:item id="3">
  175. <xf:label>Kijabe</xf:label>
  176. <xf:value>3</xf:value>
  177. </xf:item>
  178. <xf:item id="2">
  179. <xf:label>Naivasha</xf:label>
  180. <xf:value>2</xf:value>
  181. </xf:item>
  182. <xf:item id="1">
  183. <xf:label>Unknown Location</xf:label>
  184. <xf:value>1</xf:value>
  185. </xf:item>
  186. </xf:select1>
  187. <xf:select1 bind="patient_identifier_type_id">
  188. <xf:label>Identifier Type</xf:label>
  189. <xf:hint>The patient's identifier type</xf:hint>
  190. <xf:item id="2">
  191. <xf:label>Old Identification Number</xf:label>
  192. <xf:value>2</xf:value>
  193. </xf:item>
  194. <xf:item id="1">
  195. <xf:label>OpenMRS Identification Number</xf:label>
  196. <xf:value>1</xf:value>
  197. </xf:item>
  198. </xf:select1>
  199. <xf:input bind="person_attribute2">
  200. <xf:label>Birthplace</xf:label>
  201. <xf:hint>Location of persons birth</xf:hint>
  202. </xf:input>
  203. <xf:input bind="person_attribute3">
  204. <xf:label>Citizenship</xf:label>
  205. <xf:hint>Country of which this person is a member</xf:hint>
  206. </xf:input>
  207. <xf:select1 bind="person_attribute5">
  208. <xf:label>Civil Status</xf:label>
  209. <xf:hint>Marriage status of this person</xf:hint>
  210. <xf:item concept_id="1056" id="1056">
  211. <xf:label>SEPARATED</xf:label>
  212. <xf:value>1056</xf:value>
  213. </xf:item>
  214. <xf:item concept_id="1057" id="1057">
  215. <xf:label>NEVER MARRIED</xf:label>
  216. <xf:value>1057</xf:value>
  217. </xf:item>
  218. <xf:item concept_id="1058" id="1058">
  219. <xf:label>DIVORCED</xf:label>
  220. <xf:value>1058</xf:value>
  221. </xf:item>
  222. <xf:item concept_id="1059" id="1059">
  223. <xf:label>WIDOWED</xf:label>
  224. <xf:value>1059</xf:value>
  225. </xf:item>
  226. <xf:item concept_id="1060" id="1060">
  227. <xf:label>LIVING WITH PARTNER</xf:label>
  228. <xf:value>1060</xf:value>
  229. </xf:item>
  230. <xf:item concept_id="5555" id="5555">
  231. <xf:label>MARRIED</xf:label>
  232. <xf:value>5555</xf:value>
  233. </xf:item>
  234. </xf:select1>
  235. <xf:select1 bind="person_attribute7">
  236. <xf:label>Health Center</xf:label>
  237. <xf:hint>Specific Location of this person's home health center.</xf:hint>
  238. <xf:item id="3">
  239. <xf:label>Kijabe [3]</xf:label>
  240. <xf:value>3</xf:value>
  241. </xf:item>
  242. <xf:item id="2">
  243. <xf:label>Naivasha [2]</xf:label>
  244. <xf:value>2</xf:value>
  245. </xf:item>
  246. <xf:item id="1">
  247. <xf:label>Unknown Location [1]</xf:label>
  248. <xf:value>1</xf:value>
  249. </xf:item>
  250. </xf:select1>
  251. <xf:input bind="person_attribute6">
  252. <xf:label>Health District</xf:label>
  253. <xf:hint>District/region in which this patient' home health center resides</xf:hint>
  254. </xf:input>
  255. <xf:input bind="person_attribute4">
  256. <xf:label>Mother's Name</xf:label>
  257. <xf:hint>First or last name of this person's mother</xf:hint>
  258. </xf:input>
  259. <xf:input bind="person_attribute1">
  260. <xf:label>Race</xf:label>
  261. <xf:hint>Group of persons related by common descent or heredity</xf:hint>
  262. </xf:input>
  263. <xf:input bind="person_attribute8">
  264. <xf:label>Hair Colour</xf:label>
  265. <xf:hint>Hair colour</xf:hint>
  266. </xf:input>
  267. <xf:input bind="person_address_address1">
  268. <xf:label>Address 1</xf:label>
  269. </xf:input>
  270. <xf:input bind="person_address_address2">
  271. <xf:label>Address 2</xf:label>
  272. </xf:input>
  273. <xf:input bind="person_address_city_village">
  274. <xf:label>City/Village</xf:label>
  275. </xf:input>
  276. <xf:input bind="person_address_state_province">
  277. <xf:label>State/Province</xf:label>
  278. </xf:input>
  279. <xf:input bind="person_address_postal_code">
  280. <xf:label>Postal Code</xf:label>
  281. </xf:input>
  282. <xf:input bind="person_address_country">
  283. <xf:label>Country</xf:label>
  284. </xf:input>
  285. <xf:input bind="person_address_latitude">
  286. <xf:label>Latitude</xf:label>
  287. </xf:input>
  288. <xf:input bind="person_address_longitude">
  289. <xf:label>Longitude</xf:label>
  290. </xf:input>
  291. <xf:input bind="person_address_county_district">
  292. <xf:label>County/District</xf:label>
  293. </xf:input>
  294. <xf:input bind="person_address_neighborhood_cell">
  295. <xf:label>Neighborhood Cell</xf:label>
  296. </xf:input>
  297. <xf:input bind="person_address_region">
  298. <xf:label>Region</xf:label>
  299. </xf:input>
  300. <xf:input bind="person_address_subregion">
  301. <xf:label>Sub Region</xf:label>
  302. </xf:input>
  303. <xf:input bind="person_address_township_division">
  304. <xf:label>Township/Division</xf:label>
  305. </xf:input>
  306. <xf:group id="other_identifiers">
  307. <xf:label>Other dentifiers</xf:label>
  308. <xf:repeat bind="other_identifiers">
  309. <xf:input bind="other_identifier">
  310. <xf:label>Other Identifier</xf:label>
  311. <xf:hint>The patient's other identifier value</xf:hint>
  312. </xf:input>
  313. <xf:select1 bind="other_identifier_type_id">
  314. <xf:label>Identifier Type</xf:label>
  315. <xf:hint>The patient's other identifier type</xf:hint>
  316. <xf:item id="2">
  317. <xf:label>Old Identification Number</xf:label>
  318. <xf:value>2</xf:value>
  319. </xf:item>
  320. <xf:item id="1">
  321. <xf:label>OpenMRS Identification Number</xf:label>
  322. <xf:value>1</xf:value>
  323. </xf:item>
  324. </xf:select1>
  325. <xf:select1 bind="other_identifier_location_id">
  326. <xf:label>Identifier Location</xf:label>
  327. <xf:hint>The patient's other identifier location</xf:hint>
  328. <xf:item id="3">
  329. <xf:label>Kijabe [3]</xf:label>
  330. <xf:value>3</xf:value>
  331. </xf:item>
  332. <xf:item id="2">
  333. <xf:label>Naivasha [2]</xf:label>
  334. <xf:value>2</xf:value>
  335. </xf:item>
  336. <xf:item id="1">
  337. <xf:label>Unknown Location [1]</xf:label>
  338. <xf:value>1</xf:value>
  339. </xf:item>
  340. </xf:select1>
  341. </xf:repeat>
  342. </xf:group>
  343. <xf:input bind="person_attribute9">
  344. <xf:label>Phone Number</xf:label>
  345. <xf:hint>Phone number</xf:hint>
  346. </xf:input>
  347. <xf:input bind="person_attribute10">
  348. <xf:label>Chief/Local Council</xf:label>
  349. <xf:hint>Chief or local council name</xf:hint>
  350. </xf:input>
  351. <xf:input bind="encounter.encounter_datetime">
  352. <xf:label>ENCOUNTER DATETIME</xf:label>
  353. </xf:input>
  354. <xf:select1 bind="encounter.provider_id">
  355. <xf:label>PROVIDER ID</xf:label>
  356. <xf:item id="2">
  357. <xf:label>Bob Nurse [100-2]</xf:label>
  358. <xf:value>2</xf:value>
  359. </xf:item>
  360. <xf:item id="1">
  361. <xf:label>Doctor Anne [100-1]</xf:label>
  362. <xf:value>1</xf:value>
  363. </xf:item>
  364. <xf:item id="3">
  365. <xf:label>Beatrice Ondoka [100-3]</xf:label>
  366. <xf:value>3</xf:value>
  367. </xf:item>
  368. <xf:item id="7">
  369. <xf:label>Beatrice Ondoka [7]</xf:label>
  370. <xf:value>7</xf:value>
  371. </xf:item>
  372. </xf:select1>
  373. <xf:input bind="identifier">
  374. <xf:label>Identifier</xf:label>
  375. <xf:hint>The patient identifier</xf:hint>
  376. </xf:input>
  377. <xf:input bind="patient_id">
  378. <xf:label>Patient ID</xf:label>
  379. <xf:hint>The patient ID</xf:hint>
  380. </xf:input>
  381. </xf:group>
  382. </xf:xforms>
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