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  1. <?xml version='1.0' encoding='UTF-8' ?>
  2. <xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" 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">
  3.   <xf:model id="openmrs_model">
  4.     <xf:instance id="openmrs_model_instance">
  5.       <form id="11" name="Historia Clínica Subsecuente" version="1.0" uuid="d7ea83f7-0d91-4d62-91b4-84f018cb4591" xmlns:openmrs="formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/11-1" xmlns:xd="http://schemas.microsoft.com/office/infopath/2003">
  6.   <header>
  7.     <enterer></enterer>
  8.     <date_entered></date_entered>
  9.     <session></session>
  10.     <uid></uid>
  11.   </header>
  12.   <patient>
  13.     <patient.patient_id openmrs_table="patient" openmrs_attribute="patient_id"></patient.patient_id>
  14.   </patient>
  15.   <encounter>
  16.     <encounter.encounter_datetime openmrs_table="encounter" openmrs_attribute="encounter_datetime">'today()'</encounter.encounter_datetime>
  17.     <encounter.location_id openmrs_table="encounter" openmrs_attribute="location_id"></encounter.location_id>
  18.     <encounter.provider_id openmrs_table="encounter" openmrs_attribute="provider_id" provider_id_type="PROVIDER.ID"></encounter.provider_id>
  19.   </encounter>
  20.   <obs openmrs_concept="1238^MEDICAL RECORD OBSERVATIONS^99DCT" openmrs_datatype="ZZ">
  21.     <method_of_enrollment openmrs_concept="160540^Method of enrollment^99DCT" openmrs_datatype="CWE" multiple="0">
  22.         <date xsi:nil="true"></date>
  23.         <time xsi:nil="true"></time>
  24.         <value xsi:nil="true"></value>
  25.     </method_of_enrollment>
  26.     <services_ordered openmrs_concept="31^SERVICES ORDERED^99DCT" openmrs_datatype="CWE">
  27.       <family_planning_services openmrs_concept="5483^FAMILY PLANNING SERVICES^99DCT" openmrs_datatype="ZZ">
  28.             <date xsi:nil="true"></date>
  29.             <time xsi:nil="true"></time>
  30.             <value xsi:nil="true"></value>
  31.       </family_planning_services>
  32.       <general_medicine_service openmrs_concept="161627^General medicine service^99DCT" openmrs_datatype="ZZ">
  33.             <date xsi:nil="true"></date>
  34.             <time xsi:nil="true"></time>
  35.             <value xsi:nil="true"></value>
  36.       </general_medicine_service>
  37.       <mental_health_services openmrs_concept="5489^MENTAL HEALTH SERVICES^99DCT" openmrs_datatype="ZZ">
  38.             <date xsi:nil="true"></date>
  39.             <time xsi:nil="true"></time>
  40.             <value xsi:nil="true"></value>
  41.       </mental_health_services>
  42.       <servicio_de_pediatria openmrs_concept="160537^Servicio de Pediatria^99DCT" openmrs_datatype="ZZ">
  43.             <date xsi:nil="true"></date>
  44.             <time xsi:nil="true"></time>
  45.             <value xsi:nil="true"></value>
  46.       </servicio_de_pediatria>
  47.     </services_ordered>
  48.     <motivo_de_consulta openmrs_concept="160531^Chief complaint (text)^99DCT" openmrs_datatype="ST">
  49.         <date xsi:nil="true"></date>
  50.         <time xsi:nil="true"></time>
  51.         <value xsi:nil="true"></value>
  52.     </motivo_de_consulta>
  53.     <historia_de_la_enfermedad_actual openmrs_concept="1390^HISTORY OF PRESENT ILLNESS^99DCT" openmrs_datatype="ST">
  54.         <date xsi:nil="true"></date>
  55.         <time xsi:nil="true"></time>
  56.         <value xsi:nil="true"></value>
  57.     </historia_de_la_enfermedad_actual>
  58.     <antecedentes_heredofamiliares_madre openmrs_concept="163295^Family history (Mother)^99DCT" openmrs_datatype="ST">
  59.         <date xsi:nil="true"></date>
  60.         <time xsi:nil="true"></time>
  61.         <value xsi:nil="true"></value>
  62.     </antecedentes_heredofamiliares_madre>
  63.     <presumed_diagnosis openmrs_concept="159393^Presumed diagnosis^99DCT" openmrs_datatype="ST">
  64.         <date xsi:nil="true"></date>
  65.         <time xsi:nil="true"></time>
  66.         <value xsi:nil="true"></value>
  67.     </presumed_diagnosis>
  68.     <treatment_plan_text openmrs_concept="163104^Treatment plan (text)^99DCT" openmrs_datatype="ST">
  69.         <date xsi:nil="true"></date>
  70.         <time xsi:nil="true"></time>
  71.         <value xsi:nil="true"></value>
  72.     </treatment_plan_text>
  73.     <laboratory_orders openmrs_concept="1283^LABORATORY ORDERS^99DCT" openmrs_datatype="ST">
  74.         <date xsi:nil="true"></date>
  75.         <time xsi:nil="true"></time>
  76.         <value xsi:nil="true"></value>
  77.     </laboratory_orders>
  78.     <differential_diagnosis openmrs_concept="163333^Differential diagnosis^99DCT" openmrs_datatype="ST">
  79.         <date xsi:nil="true"></date>
  80.         <time xsi:nil="true"></time>
  81.         <value xsi:nil="true"></value>
  82.     </differential_diagnosis>
  83.   </obs>
  84.   </form>
  85.     </xf:instance>
  86.     <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" />
  87.     <xf:bind id="encounter.encounter_datetime" nodeset="/form/encounter/encounter.encounter_datetime" type="xsd:date" constraint=". &lt;= today()" message="Encounter date cannot be after today" required="true()" />
  88.     <xf:bind id="encounter.location_id" nodeset="/form/encounter/encounter.location_id" type="xsd:int" required="true()" />
  89.     <xf:bind id="encounter.provider_id" nodeset="/form/encounter/encounter.provider_id" type="xsd:int" required="true()" />
  90.     <xf:bind id="method_of_enrollment" nodeset="/form/obs/method_of_enrollment/value" type="xsd:string" />
  91.     <xf:bind id="services_ordered" nodeset="/form/obs/services_ordered" type="xsd:string" />
  92.     <xf:bind id="family_planning_services" nodeset="/form/obs/services_ordered/family_planning_services/value" />
  93.     <xf:bind id="general_medicine_service" nodeset="/form/obs/services_ordered/general_medicine_service/value" />
  94.     <xf:bind id="mental_health_services" nodeset="/form/obs/services_ordered/mental_health_services/value" />
  95.     <xf:bind id="servicio_de_pediatria" nodeset="/form/obs/services_ordered/servicio_de_pediatria/value" />
  96.     <xf:bind id="motivo_de_consulta" nodeset="/form/obs/motivo_de_consulta/value" type="xsd:string" />
  97.     <xf:bind id="historia_de_la_enfermedad_actual" nodeset="/form/obs/historia_de_la_enfermedad_actual/value" type="xsd:string" />
  98.     <xf:bind id="antecedentes_heredofamiliares_madre" nodeset="/form/obs/antecedentes_heredofamiliares_madre/value" type="xsd:string" />
  99.     <xf:bind id="presumed_diagnosis" nodeset="/form/obs/presumed_diagnosis/value" type="xsd:string" />
  100.     <xf:bind id="treatment_plan_text" nodeset="/form/obs/treatment_plan_text/value" type="xsd:string" />
  101.     <xf:bind id="laboratory_orders" nodeset="/form/obs/laboratory_orders/value" type="xsd:string" />
  102.     <xf:bind id="differential_diagnosis" nodeset="/form/obs/differential_diagnosis/value" type="xsd:string" />
  103.   </xf:model>
  104.   <xf:group>
  105.     <xf:label>Page1</xf:label>
  106.     <xf:input bind="patient.patient_id">
  107.       <xf:label>PATIENT ID     </xf:label>
  108.     </xf:input>
  109.     <xf:input bind="encounter.encounter_datetime">
  110.       <xf:label>ENCOUNTER DATETIME     </xf:label>
  111.     </xf:input>
  112.     <xf:select1 bind="encounter.location_id">
  113.       <xf:label>LOCATION ID     </xf:label>
  114.       <xf:item>
  115.         <xf:label>Almacen [14]</xf:label>
  116.         <xf:value>14</xf:value>
  117.       </xf:item>
  118.       <xf:item>
  119.         <xf:label>Clinica Red Segura [9]</xf:label>
  120.         <xf:value>9</xf:value>
  121.       </xf:item>
  122.       <xf:item>
  123.         <xf:label>Consultorio 1 [10]</xf:label>
  124.         <xf:value>10</xf:value>
  125.       </xf:item>
  126.       <xf:item>
  127.         <xf:label>Consultorio 2 [11]</xf:label>
  128.         <xf:value>11</xf:value>
  129.       </xf:item>
  130.       <xf:item>
  131.         <xf:label>Recepcion [12]</xf:label>
  132.         <xf:value>12</xf:value>
  133.       </xf:item>
  134.       <xf:item>
  135.         <xf:label>SFH [13]</xf:label>
  136.         <xf:value>13</xf:value>
  137.       </xf:item>
  138.       <xf:item>
  139.         <xf:label>Unknown Location [1]</xf:label>
  140.         <xf:value>1</xf:value>
  141.       </xf:item>
  142.     </xf:select1>
  143.     <xf:select1 bind="encounter.provider_id">
  144.       <xf:label>PROVIDER ID     </xf:label>
  145.       <xf:item>
  146.         <xf:label>Super User [UNKNOWN]</xf:label>
  147.         <xf:value>1</xf:value>
  148.       </xf:item>
  149.       <xf:item>
  150.         <xf:label>John Smith [clerk]</xf:label>
  151.         <xf:value>2</xf:value>
  152.       </xf:item>
  153.       <xf:item>
  154.         <xf:label>Jane Smith [nurse]</xf:label>
  155.         <xf:value>3</xf:value>
  156.       </xf:item>
  157.       <xf:item>
  158.         <xf:label>Jake Smith [doctor]</xf:label>
  159.         <xf:value>4</xf:value>
  160.       </xf:item>
  161.     </xf:select1>
  162.     <xf:select1 bind="method_of_enrollment">
  163.       <xf:label>Method of enrollment</xf:label>
  164.       <xf:item concept_id="160540">
  165.         <xf:label>Proyecto Ruby</xf:label>
  166.         <xf:value>163328^Proyecto Ruby^99DCT</xf:value>
  167.       </xf:item>
  168.       <xf:item concept_id="160540">
  169.         <xf:label>Proyecto CDC - POM</xf:label>
  170.         <xf:value>163329^Proyecto CDC - POM^99DCT</xf:value>
  171.       </xf:item>
  172.       <xf:item concept_id="160540">
  173.         <xf:label>Voluntariamente (No programa)</xf:label>
  174.         <xf:value>163330^Voluntariamente (No programa)^99DCT</xf:value>
  175.       </xf:item>
  176.     </xf:select1>
  177.     <xf:select1 bind="services_ordered">
  178.       <xf:label>SERVICES ORDERED</xf:label>
  179.       <xf:hint>Services requested during a clinical encounter.</xf:hint>
  180.       <xf:item concept_id="31">
  181.         <xf:label>FAMILY PLANNING SERVICES</xf:label>
  182.         <xf:value>5483^FAMILY PLANNING SERVICES^99DCT</xf:value>
  183.       </xf:item>
  184.       <xf:item concept_id="31">
  185.         <xf:label>General medicine service</xf:label>
  186.         <xf:value>161627^General medicine service^99DCT</xf:value>
  187.       </xf:item>
  188.       <xf:item concept_id="31">
  189.         <xf:label>MENTAL HEALTH SERVICES</xf:label>
  190.         <xf:value>5489^MENTAL HEALTH SERVICES^99DCT</xf:value>
  191.       </xf:item>
  192.       <xf:item concept_id="31">
  193.         <xf:label>Servicio de Pediatria</xf:label>
  194.         <xf:value>160537^Servicio de Pediatria^99DCT</xf:value>
  195.       </xf:item>
  196.     </xf:select1>
  197.     <xf:input bind="motivo_de_consulta">
  198.       <xf:label>Chief complaint (text)</xf:label>
  199.     </xf:input>
  200.     <xf:input bind="historia_de_la_enfermedad_actual">
  201.       <xf:label>HISTORY OF PRESENT ILLNESS</xf:label>
  202.     </xf:input>
  203.     <xf:input bind="antecedentes_heredofamiliares_madre">
  204.       <xf:label>Family history (Mother)</xf:label>
  205.     </xf:input>
  206.     <xf:input bind="presumed_diagnosis">
  207.       <xf:label>Presumed diagnosis</xf:label>
  208.       <xf:hint>The diagnosis is yet to be confirmed by special tests. This is the diagnosis based on clinical findings.</xf:hint>
  209.     </xf:input>
  210.     <xf:input bind="treatment_plan_text">
  211.       <xf:label>Treatment plan (text)</xf:label>
  212.       <xf:hint>Description of course of treatment; what treatment was provided.</xf:hint>
  213.     </xf:input>
  214.     <xf:input bind="laboratory_orders">
  215.       <xf:label>LABORATORY ORDERS</xf:label>
  216.       <xf:hint>Labs that are ordered at a particular patient visit.</xf:hint>
  217.     </xf:input>
  218.     <xf:input bind="differential_diagnosis">
  219.       <xf:label>Differential diagnosis</xf:label>
  220.     </xf:input>
  221.   </xf:group>
  222. </xf:xforms>
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