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  1. <?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/7-1' is not a valid URI
  2. </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 213: xmlns:openmrs: 'formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/7-1' is not a valid URI
  3. </div><h3>Below is a rendering of the page up to the first error.</h3></parsererror>
  4.   <xf:model id="openmrs_model">
  5.     <xf:instance id="openmrs_model_instance">
  6.       <form xmlns:openmrs="formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/7-1" xmlns:xd="http://schemas.microsoft.com/office/infopath/2003" id="7" name="Historia Clinica *DUPLIC*" version="1.0" uuid="1ff8375e-9aba-4d68-a304-fee81dc9e8ce">
  7.   <header>
  8.     <enterer/>
  9.     <date_entered/>
  10.     <session/>
  11.     <uid/>
  12.   </header>
  13.   <patient>
  14.     <patient.patient_id openmrs_table="patient" openmrs_attribute="patient_id"/>
  15.     <patient_relative>
  16.       <patient_relative.person/>
  17.       <patient_relative.relationship/>
  18.     </patient_relative>
  19.   </patient>
  20.   <encounter>
  21.     <encounter.encounter_datetime openmrs_table="encounter" openmrs_attribute="encounter_datetime">2016-05-31</encounter.encounter_datetime>
  22.     <encounter.location_id openmrs_table="encounter" openmrs_attribute="location_id"/>
  23.     <encounter.provider_id openmrs_table="encounter" openmrs_attribute="provider_id" provider_id_type="PROVIDER.ID"/>
  24.   </encounter>
  25.   <obs openmrs_concept="1238^MEDICAL RECORD OBSERVATIONS^99DCT" openmrs_datatype="ZZ">
  26.     <patologicos_past_medical_history openmrs_concept="1633^PAST MEDICAL HISTORY^99DCT" openmrs_datatype="ZZ">
  27.         <date xsi:nil="true"/>
  28.         <time xsi:nil="true"/>
  29.         <value xsi:nil="true"/>
  30.     </patologicos_past_medical_history>
  31.     <past_medical_history_added_text openmrs_concept="160221^Past medical history added (text)^99DCT" openmrs_datatype="ST">
  32.         <date xsi:nil="true"/>
  33.         <time xsi:nil="true"/>
  34.         <value xsi:nil="true"/>
  35.     </past_medical_history_added_text>
  36.     <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
  37.         <date xsi:nil="true"/>
  38.         <time xsi:nil="true"/>
  39.         <value xsi:nil="true"/>
  40.     </diagnosis_date>
  41.     <sign_slash_symptom_present openmrs_concept="1729^SIGN/SYMPTOM PRESENT^99DCT" openmrs_datatype="CWE" multiple="0">
  42.         <date xsi:nil="true"/>
  43.         <time xsi:nil="true"/>
  44.         <value xsi:nil="true"/>
  45.     </sign_slash_symptom_present>
  46.     <past_medical_history_added openmrs_concept="1628^PAST MEDICAL HISTORY ADDED^99DCT" openmrs_datatype="CWE" multiple="0">
  47.         <date xsi:nil="true"/>
  48.         <time xsi:nil="true"/>
  49.         <value xsi:nil="true"/>
  50.     </past_medical_history_added>
  51.     <caf openmrs_concept="163302^Coffee use^99DCT" openmrs_datatype="CWE" multiple="0">
  52.         <date xsi:nil="true"/>
  53.         <time xsi:nil="true"/>
  54.         <value xsi:nil="true"/>
  55.     </caf>
  56.     <t openmrs_concept="163301^Tea use^99DCT" openmrs_datatype="CWE" multiple="0">
  57.         <date xsi:nil="true"/>
  58.         <time xsi:nil="true"/>
  59.         <value xsi:nil="true"/>
  60.     </t>
  61.     <drogas openmrs_concept="160666^Current drug user^99DCT" openmrs_datatype="CWE" multiple="0">
  62.         <date xsi:nil="true"/>
  63.         <time xsi:nil="true"/>
  64.         <value xsi:nil="true"/>
  65.     </drogas>
  66.     <tabaco_slash_cigarro openmrs_concept="163201^Smoking Status^99DCT" openmrs_datatype="CWE" multiple="0">
  67.         <date xsi:nil="true"/>
  68.         <time xsi:nil="true"/>
  69.         <value xsi:nil="true"/>
  70.     </tabaco_slash_cigarro>
  71.     <alcohol openmrs_concept="159449^Alcohol use status^99DCT" openmrs_datatype="CWE" multiple="0">
  72.         <date xsi:nil="true"/>
  73.         <time xsi:nil="true"/>
  74.         <value xsi:nil="true"/>
  75.     </alcohol>
  76.     <antecedentes_heredofamiliares_otros openmrs_concept="163298^Family history (Other)^99DCT" openmrs_datatype="ST">
  77.         <date xsi:nil="true"/>
  78.         <time xsi:nil="true"/>
  79.         <value xsi:nil="true"/>
  80.     </antecedentes_heredofamiliares_otros>
  81.     <nios_hijos>
  82.     </nios_hijos>
  83.     <antecedentes_heredofamiliares_hija openmrs_concept="163299^Family history (Daughter)^99DCT" openmrs_datatype="ST">
  84.         <date xsi:nil="true"/>
  85.         <time xsi:nil="true"/>
  86.         <value xsi:nil="true"/>
  87.     </antecedentes_heredofamiliares_hija>
  88.     <antecedentes_heredofamiliares_hijo openmrs_concept="163297^Family history (Son)^99DCT" openmrs_datatype="ST">
  89.         <date xsi:nil="true"/>
  90.         <time xsi:nil="true"/>
  91.         <value xsi:nil="true"/>
  92.     </antecedentes_heredofamiliares_hijo>
  93.     <antecedentes_heredofamiliares_hermanas openmrs_concept="163300^Family history (Sister)^99DCT" openmrs_datatype="ST">
  94.         <date xsi:nil="true"/>
  95.         <time xsi:nil="true"/>
  96.         <value xsi:nil="true"/>
  97.     </antecedentes_heredofamiliares_hermanas>
  98.     <antecedentes_heredofamiliares_hermanos openmrs_concept="163296^Family history (Brother)^99DCT" openmrs_datatype="ST">
  99.         <date xsi:nil="true"/>
  100.         <time xsi:nil="true"/>
  101.         <value xsi:nil="true"/>
  102.     </antecedentes_heredofamiliares_hermanos>
  103.     <antecedentes_heredofamiliares_padre openmrs_concept="163294^Family history (Father)^99DCT" openmrs_datatype="ST">
  104.         <date xsi:nil="true"/>
  105.         <time xsi:nil="true"/>
  106.         <value xsi:nil="true"/>
  107.     </antecedentes_heredofamiliares_padre>
  108.     <antecedentes_heredofamiliares_madre openmrs_concept="163295^Family history (Mother)^99DCT" openmrs_datatype="ST">
  109.         <date xsi:nil="true"/>
  110.         <time xsi:nil="true"/>
  111.         <value xsi:nil="true"/>
  112.     </antecedentes_heredofamiliares_madre>
  113.     <motivo_de_consulta openmrs_concept="160531^Chief complaint (text)^99DCT" openmrs_datatype="ST">
  114.         <date xsi:nil="true"/>
  115.         <time xsi:nil="true"/>
  116.         <value xsi:nil="true"/>
  117.     </motivo_de_consulta>
  118.     <historia_de_la_enfermedad_actual openmrs_concept="1390^HISTORY OF PRESENT ILLNESS^99DCT" openmrs_datatype="ST">
  119.         <date xsi:nil="true"/>
  120.         <time xsi:nil="true"/>
  121.         <value xsi:nil="true"/>
  122.     </historia_de_la_enfermedad_actual>
  123.   </obs>
  124.   </form>
  125.     </xf:instance>
  126.     <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"/>
  127.     <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()"/>
  128.     <xf:bind id="encounter.location_id" nodeset="/form/encounter/encounter.location_id" type="xsd:string" required="true()"/>
  129.     <xf:bind id="encounter.provider_id" nodeset="/form/encounter/encounter.provider_id" type="xsd:string" required="true()"/>
  130.     <xf:bind id="patologicos_past_medical_history" nodeset="/form/obs/patologicos_past_medical_history/value"/>
  131.     <xf:bind id="past_medical_history_added_text" nodeset="/form/obs/past_medical_history_added_text/value" type="xsd:string"/>
  132.     <xf:bind id="diagnosis_date" nodeset="/form/obs/diagnosis_date/value" type="xsd:date"/>
  133.     <xf:bind id="sign_slash_symptom_present" nodeset="/form/obs/sign_slash_symptom_present/value" type="xsd:string"/>
  134.     <xf:bind id="past_medical_history_added" nodeset="/form/obs/past_medical_history_added/value" type="xsd:string"/>
  135.     <xf:bind id="caf" nodeset="/form/obs/caf/value" type="xsd:string"/>
  136.     <xf:bind id="t" nodeset="/form/obs/t/value" type="xsd:string"/>
  137.     <xf:bind id="drogas" nodeset="/form/obs/drogas/value" type="xsd:string"/>
  138.     <xf:bind id="tabaco_slash_cigarro" nodeset="/form/obs/tabaco_slash_cigarro/value" type="xsd:string"/>
  139.     <xf:bind id="alcohol" nodeset="/form/obs/alcohol/value" type="xsd:string"/>
  140.     <xf:bind id="antecedentes_heredofamiliares_otros" nodeset="/form/obs/antecedentes_heredofamiliares_otros/value" type="xsd:string"/>
  141.     <xf:bind id="antecedentes_heredofamiliares_hija" nodeset="/form/obs/antecedentes_heredofamiliares_hija/value" type="xsd:string"/>
  142.     <xf:bind id="antecedentes_heredofamiliares_hijo" nodeset="/form/obs/antecedentes_heredofamiliares_hijo/value" type="xsd:string"/>
  143.     <xf:bind id="antecedentes_heredofamiliares_hermanas" nodeset="/form/obs/antecedentes_heredofamiliares_hermanas/value" type="xsd:string"/>
  144.     <xf:bind id="antecedentes_heredofamiliares_hermanos" nodeset="/form/obs/antecedentes_heredofamiliares_hermanos/value" type="xsd:string"/>
  145.     <xf:bind id="antecedentes_heredofamiliares_padre" nodeset="/form/obs/antecedentes_heredofamiliares_padre/value" type="xsd:string"/>
  146.     <xf:bind id="antecedentes_heredofamiliares_madre" nodeset="/form/obs/antecedentes_heredofamiliares_madre/value" type="xsd:string"/>
  147.     <xf:bind id="motivo_de_consulta" nodeset="/form/obs/motivo_de_consulta/value" type="xsd:string"/>
  148.     <xf:bind id="historia_de_la_enfermedad_actual" nodeset="/form/obs/historia_de_la_enfermedad_actual/value" type="xsd:string"/>
  149.     <xf:bind id="patient_relative" nodeset="/form/patient/patient_relative"/>
  150.     <xf:bind id="patient_relative.person" nodeset="/form/patient/patient_relative/patient_relative.person" type="xsd:string"/>
  151.     <xf:bind id="patient_relative.relationship" nodeset="/form/patient/patient_relative/patient_relative.relationship" type="xsd:string"/>
  152.   </xf:model>
  153.   <xf:group id="1">
  154.     <xf:label>Page1</xf:label>
  155.     <xf:input bind="patient.patient_id">
  156.       <xf:label>PATIENT ID</xf:label>
  157.     </xf:input>
  158.     <xf:input bind="encounter.encounter_datetime">
  159.       <xf:label>ENCOUNTER DATETIME</xf:label>
  160.     </xf:input>
  161.     <xf:select1 bind="encounter.location_id">
  162.       <xf:label>LOCATION ID</xf:label>
  163.       <xf:item id="8">
  164.         <xf:label>Amani Hospital [8]</xf:label>
  165.         <xf:value>8</xf:value>
  166.       </xf:item>
  167.       <xf:item id="6">
  168.         <xf:label>Inpatient Ward [6]</xf:label>
  169.         <xf:value>6</xf:value>
  170.       </xf:item>
  171.       <xf:item id="4">
  172.         <xf:label>Isolation Ward [4]</xf:label>
  173.         <xf:value>4</xf:value>
  174.       </xf:item>
  175.       <xf:item id="3">
  176.         <xf:label>Laboratory [3]</xf:label>
  177.         <xf:value>3</xf:value>
  178.       </xf:item>
  179.       <xf:item id="7">
  180.         <xf:label>Outpatient Clinic [7]</xf:label>
  181.         <xf:value>7</xf:value>
  182.       </xf:item>
  183.       <xf:item id="2">
  184.         <xf:label>Pharmacy [2]</xf:label>
  185.         <xf:value>2</xf:value>
  186.       </xf:item>
  187.       <xf:item id="5">
  188.         <xf:label>Registration Desk [5]</xf:label>
  189.         <xf:value>5</xf:value>
  190.       </xf:item>
  191.       <xf:item id="1">
  192.         <xf:label>Unknown Location [1]</xf:label>
  193.         <xf:value>1</xf:value>
  194.       </xf:item>
  195.     </xf:select1>
  196.     <xf:select1 bind="encounter.provider_id">
  197.       <xf:label>PROVIDER ID</xf:label>
  198.       <xf:item id="1">
  199.         <xf:label>Super User [UNKNOWN]</xf:label>
  200.         <xf:value>1</xf:value>
  201.       </xf:item>
  202.       <xf:item id="2">
  203.         <xf:label>John Smith [clerk]</xf:label>
  204.         <xf:value>2</xf:value>
  205.       </xf:item>
  206.       <xf:item id="3">
  207.         <xf:label>Jane Smith [nurse]</xf:label>
  208.         <xf:value>3</xf:value>
  209.       </xf:item>
  210.       <xf:item id="4">
  211.         <xf:label>Jake Smith [doctor]</xf:label>
  212.         <xf:value>4</xf:value>
  213.       </xf:item>
  214.     </xf:select1>
  215.     <xf:input bind="past_medical_history_added_text">
  216.       <xf:label>Past medical history added (text)</xf:label>
  217.     </xf:input>
  218.     <xf:input bind="diagnosis_date">
  219.       <xf:label>Diagnosis date</xf:label>
  220.       <xf:hint>The date the diagnosis was first made for the patient.</xf:hint>
  221.     </xf:input>
  222.     <xf:select1 bind="sign_slash_symptom_present">
  223.       <xf:label>SIGN/SYMPTOM PRESENT</xf:label>
  224.       <xf:hint>Whether the sign or symptom is/was present</xf:hint>
  225.       <xf:item concept_id="1729" id="1066^No^99DCT">
  226.         <xf:label>No</xf:label>
  227.         <xf:value>1066^No^99DCT</xf:value>
  228.       </xf:item>
  229.       <xf:item concept_id="1729" id="1067^Unknown^99DCT">
  230.         <xf:label>Unknown</xf:label>
  231.         <xf:value>1067^Unknown^99DCT</xf:value>
  232.       </xf:item>
  233.       <xf:item concept_id="1729" id="1065^Yes^99DCT">
  234.         <xf:label>Yes</xf:label>
  235.         <xf:value>1065^Yes^99DCT</xf:value>
  236.       </xf:item>
  237.     </xf:select1>
  238.     <xf:select1 bind="past_medical_history_added">
  239.       <xf:label>PAST MEDICAL HISTORY ADDED</xf:label>
  240.       <xf:hint>Coded list of past medical history problems but not procedures which are coded under Past Surgical History.</xf:hint>
  241.     </xf:select1>
  242.     <xf:select1 bind="caf">
  243.       <xf:label>Coffee use</xf:label>
  244.       <xf:hint>Does the patient drink coffee</xf:hint>
  245.       <xf:item concept_id="163302" id="1065^Yes^99DCT">
  246.         <xf:label>Yes</xf:label>
  247.         <xf:value>1065^Yes^99DCT</xf:value>
  248.       </xf:item>
  249.       <xf:item concept_id="163302" id="1066^No^99DCT">
  250.         <xf:label>No</xf:label>
  251.         <xf:value>1066^No^99DCT</xf:value>
  252.       </xf:item>
  253.       <xf:item concept_id="163302" id="1067^Unknown^99DCT">
  254.         <xf:label>Unknown</xf:label>
  255.         <xf:value>1067^Unknown^99DCT</xf:value>
  256.       </xf:item>
  257.     </xf:select1>
  258.     <xf:select1 bind="t">
  259.       <xf:label>Tea use</xf:label>
  260.       <xf:hint>Question as to whether patient drinks tea</xf:hint>
  261.       <xf:item concept_id="163301" id="1065^Yes^99DCT">
  262.         <xf:label>Yes</xf:label>
  263.         <xf:value>1065^Yes^99DCT</xf:value>
  264.       </xf:item>
  265.       <xf:item concept_id="163301" id="1066^No^99DCT">
  266.         <xf:label>No</xf:label>
  267.         <xf:value>1066^No^99DCT</xf:value>
  268.       </xf:item>
  269.       <xf:item concept_id="163301" id="1067^Unknown^99DCT">
  270.         <xf:label>Unknown</xf:label>
  271.         <xf:value>1067^Unknown^99DCT</xf:value>
  272.       </xf:item>
  273.     </xf:select1>
  274.     <xf:select1 bind="drogas">
  275.       <xf:label>Current drug user</xf:label>
  276.       <xf:hint>Taking drugs at present</xf:hint>
  277.       <xf:item concept_id="160666" id="1066^No^99DCT">
  278.         <xf:label>No</xf:label>
  279.         <xf:value>1066^No^99DCT</xf:value>
  280.       </xf:item>
  281.       <xf:item concept_id="160666" id="1065^Yes^99DCT">
  282.         <xf:label>Yes</xf:label>
  283.         <xf:value>1065^Yes^99DCT</xf:value>
  284.       </xf:item>
  285.       <xf:item concept_id="160666" id="1067^Unknown^99DCT">
  286.         <xf:label>Unknown</xf:label>
  287.         <xf:value>1067^Unknown^99DCT</xf:value>
  288.       </xf:item>
  289.     </xf:select1>
  290.     <xf:select1 bind="tabaco_slash_cigarro">
  291.       <xf:label>Smoking Status</xf:label>
  292.       <xf:item concept_id="163201" id="163200^Unknown if ever smoked^99DCT">
  293.         <xf:label>Unknown if ever smoked</xf:label>
  294.         <xf:value>163200^Unknown if ever smoked^99DCT</xf:value>
  295.       </xf:item>
  296.       <xf:item concept_id="163201" id="163199^Current every day smoker^99DCT">
  297.         <xf:label>Current every day smoker</xf:label>
  298.         <xf:value>163199^Current every day smoker^99DCT</xf:value>
  299.       </xf:item>
  300.       <xf:item concept_id="163201" id="152807^Former Smoker^99DCT">
  301.         <xf:label>Former Smoker</xf:label>
  302.         <xf:value>152807^Former Smoker^99DCT</xf:value>
  303.       </xf:item>
  304.       <xf:item concept_id="163201" id="163196^Current light tobacco smoker^99DCT">
  305.         <xf:label>Current light tobacco smoker</xf:label>
  306.         <xf:value>163196^Current light tobacco smoker^99DCT</xf:value>
  307.       </xf:item>
  308.       <xf:item concept_id="163201" id="163195^Current heavy tobacco smoker^99DCT">
  309.         <xf:label>Current heavy tobacco smoker</xf:label>
  310.         <xf:value>163195^Current heavy tobacco smoker^99DCT</xf:value>
  311.       </xf:item>
  312.       <xf:item concept_id="163201" id="152722^Smoker^99DCT">
  313.         <xf:label>Smoker</xf:label>
  314.         <xf:value>152722^Smoker^99DCT</xf:value>
  315.       </xf:item>
  316.       <xf:item concept_id="163201" id="163197^Current some day smoker^99DCT">
  317.         <xf:label>Current some day smoker</xf:label>
  318.         <xf:value>163197^Current some day smoker^99DCT</xf:value>
  319.       </xf:item>
  320.     </xf:select1>
  321.     <xf:select1 bind="alcohol">
  322.       <xf:label>Alcohol use status</xf:label>
  323.       <xf:hint>Whether the patient consumes alcohol or not</xf:hint>
  324.       <xf:item concept_id="159449" id="159452^In the past^99DCT">
  325.         <xf:label>In the past</xf:label>
  326.         <xf:value>159452^In the past^99DCT</xf:value>
  327.       </xf:item>
  328.       <xf:item concept_id="159449" id="159450^Currently^99DCT">
  329.         <xf:label>Currently</xf:label>
  330.         <xf:value>159450^Currently^99DCT</xf:value>
  331.       </xf:item>
  332.       <xf:item concept_id="159449" id="1090^Never^99DCT">
  333.         <xf:label>Never</xf:label>
  334.         <xf:value>1090^Never^99DCT</xf:value>
  335.       </xf:item>
  336.     </xf:select1>
  337.     <xf:input bind="antecedentes_heredofamiliares_otros">
  338.       <xf:label>Family history (Other)</xf:label>
  339.     </xf:input>
  340.     <xf:input bind="antecedentes_heredofamiliares_hija">
  341.       <xf:label>Family history (Daughter)</xf:label>
  342.     </xf:input>
  343.     <xf:input bind="antecedentes_heredofamiliares_hijo">
  344.       <xf:label>Family history (Son)</xf:label>
  345.     </xf:input>
  346.     <xf:input bind="antecedentes_heredofamiliares_hermanas">
  347.       <xf:label>Family history (Sister)</xf:label>
  348.     </xf:input>
  349.     <xf:input bind="antecedentes_heredofamiliares_hermanos">
  350.       <xf:label>Family history (Brother)</xf:label>
  351.     </xf:input>
  352.     <xf:input bind="antecedentes_heredofamiliares_padre">
  353.       <xf:label>Family history (Father)</xf:label>
  354.     </xf:input>
  355.     <xf:input bind="antecedentes_heredofamiliares_madre">
  356.       <xf:label>Family history (Mother)</xf:label>
  357.     </xf:input>
  358.     <xf:input bind="motivo_de_consulta">
  359.       <xf:label>Chief complaint (text)</xf:label>
  360.     </xf:input>
  361.     <xf:input bind="historia_de_la_enfermedad_actual">
  362.       <xf:label>HISTORY OF PRESENT ILLNESS</xf:label>
  363.     </xf:input>
  364.     <xf:group id="patient/patient_relative">
  365.       <xf:label>RELATIONSHIPS</xf:label>
  366.       <xf:hint>Relationships that this patient has.</xf:hint>
  367.       <xf:repeat bind="patient_relative">
  368.        
  369.         <xf:input bind="patient_relative.person">
  370.           <xf:label>RELATIVE</xf:label>
  371.         </xf:input>
  372.        
  373.         <xf:select1 bind="patient_relative.relationship">
  374.           <xf:item id="1A">
  375.             <xf:label>is Doctor [1]</xf:label>
  376.             <xf:value>1A</xf:value>
  377.           </xf:item>
  378.           <xf:item id="1B">
  379.             <xf:label>is Patient [1]</xf:label>
  380.             <xf:value>1B</xf:value>
  381.           </xf:item>
  382.           <xf:item id="2A">
  383.             <xf:label>is Sibling [2]</xf:label>
  384.             <xf:value>2A</xf:value>
  385.           </xf:item>
  386.           <xf:item id="3A">
  387.             <xf:label>is Parent [3]</xf:label>
  388.             <xf:value>3A</xf:value>
  389.           </xf:item>
  390.           <xf:item id="3B">
  391.             <xf:label>is Child [3]</xf:label>
  392.             <xf:value>3B</xf:value>
  393.           </xf:item>
  394.           <xf:item id="4A">
  395.             <xf:label>is Aunt/Uncle [4]</xf:label>
  396.             <xf:value>4A</xf:value>
  397.           </xf:item>
  398.           <xf:item id="4B">
  399.             <xf:label>is Niece/Nephew [4]</xf:label>
  400.             <xf:value>4B</xf:value>
  401.           </xf:item>
  402.           <xf:item id="5A">
  403.             <xf:label>is Supervisor [5]</xf:label>
  404.             <xf:value>5A</xf:value>
  405.           </xf:item>
  406.           <xf:item id="5B">
  407.             <xf:label>is Supervisee [5]</xf:label>
  408.             <xf:value>5B</xf:value>
  409.           </xf:item>
  410.           <xf:label>RELATIONSHIP</xf:label>
  411.         </xf:select1>
  412.       </xf:repeat>
  413.     </xf:group>
  414.   </xf:group>
  415. </xf:xforms></Xform><Layout><Form id="7"><Page Text="Page1" fontWeight="normal" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, Sans-Serif" Binding="Page1" Width="900px" Height="1218.8px" backgroundColor=""><Item WidgetType="Label" Text="ENCOUNTER DATETIME" HelpText="ENCOUNTER DATETIME" Binding="encounter/encounter.encounter_datetime" Left="100px" Top="20px" 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="294px" Top="20px" Width="200px" Height="25px" TabIndex="1" 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="180px" Top="60px" 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="294px" Top="60px" Width="200px" Height="25px" TabIndex="2" 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="179px" Top="100px" 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="294px" Top="100px" Width="200px" Height="25px" TabIndex="3" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Past medical history added (text)" HelpText="Past medical history added (text)" Binding="obs/past_medical_history_added_text/value" Left="20px" Top="140px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Past medical history added (text)" Binding="obs/past_medical_history_added_text/value" Left="294px" Top="140px" Width="200px" Height="25px" TabIndex="4" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Diagnosis date" HelpText="Diagnosis date" Binding="obs/diagnosis_date/value" Left="171px" Top="180px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="DatePicker" HelpText="The date the diagnosis was first made for the patient." Binding="obs/diagnosis_date/value" Left="294px" Top="180px" Width="200px" Height="25px" TabIndex="5" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="SIGN/SYMPTOM PRESENT" HelpText="SIGN/SYMPTOM PRESENT" Binding="obs/sign_slash_symptom_present/value" Left="80px" Top="220px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="Whether the sign or symptom is/was present" Binding="obs/sign_slash_symptom_present/value" Left="294px" Top="220px" Width="200px" Height="25px" TabIndex="6" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="PAST MEDICAL HISTORY ADDED" HelpText="PAST MEDICAL HISTORY ADDED" Binding="obs/past_medical_history_added/value" Left="27px" Top="260px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="Coded list of past medical history problems but not procedures which are coded under Past Surgical History." Binding="obs/past_medical_history_added/value" Left="294px" Top="260px" Width="200px" Height="25px" TabIndex="7" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Coffee use" HelpText="Coffee use" Binding="obs/caf/value" Left="203px" Top="300px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="Does the patient drink coffee" Binding="obs/caf/value" Left="294px" Top="300px" Width="200px" Height="25px" TabIndex="8" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Tea use" HelpText="Tea use" Binding="obs/t/value" Left="227px" Top="340px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="Question as to whether patient drinks tea" Binding="obs/t/value" Left="294px" Top="340px" Width="200px" Height="25px" TabIndex="9" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Current drug user" HelpText="Current drug user" Binding="obs/drogas/value" Left="145px" Top="380px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="Taking drugs at present" Binding="obs/drogas/value" Left="294px" Top="380px" Width="200px" Height="25px" TabIndex="10" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Smoking Status" HelpText="Smoking Status" Binding="obs/tabaco_slash_cigarro/value" Left="161px" Top="420px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Alcohol use status" HelpText="Alcohol use status" Binding="obs/alcohol/value" Left="143px" Top="460px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="Whether the patient consumes alcohol or not" Binding="obs/alcohol/value" Left="294px" Top="460px" Width="200px" Height="25px" TabIndex="12" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Family history (Other)" HelpText="Family history (Other)" Binding="obs/antecedentes_heredofamiliares_otros/value" Left="111px" Top="500px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Family history (Other)" Binding="obs/antecedentes_heredofamiliares_otros/value" Left="294px" Top="500px" Width="200px" Height="25px" TabIndex="13" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Family history (Daughter)" HelpText="Family history (Daughter)" Binding="obs/antecedentes_heredofamiliares_hija/value" Left="81px" Top="540px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Family history (Daughter)" Binding="obs/antecedentes_heredofamiliares_hija/value" Left="294px" Top="540px" Width="200px" Height="25px" TabIndex="14" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Family history (Son)" HelpText="Family history (Son)" Binding="obs/antecedentes_heredofamiliares_hijo/value" Left="125px" Top="580px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Family history (Son)" Binding="obs/antecedentes_heredofamiliares_hijo/value" Left="294px" Top="580px" Width="200px" Height="25px" TabIndex="15" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Family history (Sister)" HelpText="Family history (Sister)" Binding="obs/antecedentes_heredofamiliares_hermanas/value" Left="110px" Top="620px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Family history (Sister)" Binding="obs/antecedentes_heredofamiliares_hermanas/value" Left="294px" Top="620px" Width="200px" Height="25px" TabIndex="16" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Family history (Brother)" HelpText="Family history (Brother)" Binding="obs/antecedentes_heredofamiliares_hermanos/value" Left="95px" Top="660px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Family history (Brother)" Binding="obs/antecedentes_heredofamiliares_hermanos/value" Left="294px" Top="660px" Width="200px" Height="25px" TabIndex="17" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Family history (Father)" HelpText="Family history (Father)" Binding="obs/antecedentes_heredofamiliares_padre/value" Left="105px" Top="700px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Family history (Father)" Binding="obs/antecedentes_heredofamiliares_padre/value" Left="294px" Top="700px" Width="200px" Height="25px" TabIndex="18" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Family history (Mother)" HelpText="Family history (Mother)" Binding="obs/antecedentes_heredofamiliares_madre/value" Left="100px" Top="740px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Family history (Mother)" Binding="obs/antecedentes_heredofamiliares_madre/value" Left="294px" Top="740px" Width="200px" Height="25px" TabIndex="19" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="Chief complaint (text)" HelpText="Chief complaint (text)" Binding="obs/motivo_de_consulta/value" Left="112px" Top="780px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Chief complaint (text)" Binding="obs/motivo_de_consulta/value" Left="294px" Top="780px" Width="200px" Height="25px" TabIndex="20" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="HISTORY OF PRESENT ILLNESS" HelpText="HISTORY OF PRESENT ILLNESS" Binding="obs/historia_de_la_enfermedad_actual/value" Left="35px" Top="820px" TabIndex="0" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="HISTORY OF PRESENT ILLNESS" Binding="obs/historia_de_la_enfermedad_actual/value" Left="294px" Top="820px" Width="200px" Height="25px" TabIndex="21" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Label" Text="RELATIONSHIPS" HelpText="RELATIONSHIPS" Binding="patient/patient_relative" Left="20px" Top="860px" 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="885px" 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="885px" 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="910px" Width="425px" Height="100px" TabIndex="22" 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="1050px" Width="70px" Height="30px" TabIndex="23" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="Button" Text="Close" HelpText="cancel" Binding="cancel" Left="220px" Top="1050px" Width="70px" Height="30px" TabIndex="24" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/><Item WidgetType="ListBox" HelpText="Smoking Status" Binding="obs/tabaco_slash_cigarro/value" Left="294px" Top="420px" Width="200px" Height="25px" TabIndex="11" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, sans-serif"/></Page></Form></Layout><Language><LanguageText lang="en"><xform id="7"><text xpath="xforms/model[@id='openmrs_model']/instance[@id='openmrs_model_instance']/form[@name]" value="Historia Clinica *DUPLIC*"/><text xpath="xforms/group[@id='1']/label" value="Page1"/><text xpath="xforms/group[@id='1']/input[@bind='patient.patient_id']/label" value="PATIENT ID"/><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='1']/label" value="Super User [UNKNOWN]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='2']/label" value="John Smith [clerk]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='3']/label" value="Jane Smith [nurse]"/><text xpath="xforms/group[@id='1']/select1[@bind='encounter.provider_id']/item[@id='4']/label" value="Jake Smith [doctor]"/><text xpath="xforms/group[@id='1']/input[@bind='past_medical_history_added_text']/label" value="Past medical history added (text)"/><text xpath="xforms/group[@id='1']/input[@bind='diagnosis_date']/label" value="Diagnosis date"/><text xpath="xforms/group[@id='1']/input[@bind='diagnosis_date']/hint" value="The date the diagnosis was first made for the patient."/><text xpath="xforms/group[@id='1']/select1[@bind='sign_slash_symptom_present']/label" value="SIGN/SYMPTOM PRESENT"/><text xpath="xforms/group[@id='1']/select1[@bind='sign_slash_symptom_present']/hint" value="Whether the sign or symptom is/was present"/><text xpath="xforms/group[@id='1']/select1[@bind='sign_slash_symptom_present']/item[@id='1066^No^99DCT']/label" value="No"/><text xpath="xforms/group[@id='1']/select1[@bind='sign_slash_symptom_present']/item[@id='1067^Unknown^99DCT']/label" value="Unknown"/><text xpath="xforms/group[@id='1']/select1[@bind='sign_slash_symptom_present']/item[@id='1065^Yes^99DCT']/label" value="Yes"/><text xpath="xforms/group[@id='1']/select1[@bind='past_medical_history_added']/label" value="PAST MEDICAL HISTORY ADDED"/><text xpath="xforms/group[@id='1']/select1[@bind='past_medical_history_added']/hint" value="Coded list of past medical history problems but not procedures which are coded under Past Surgical History."/><text xpath="xforms/group[@id='1']/select1[@bind='caf']/label" value="Coffee use"/><text xpath="xforms/group[@id='1']/select1[@bind='caf']/hint" value="Does the patient drink coffee"/><text xpath="xforms/group[@id='1']/select1[@bind='caf']/item[@id='1065^Yes^99DCT']/label" value="Yes"/><text xpath="xforms/group[@id='1']/select1[@bind='caf']/item[@id='1066^No^99DCT']/label" value="No"/><text xpath="xforms/group[@id='1']/select1[@bind='caf']/item[@id='1067^Unknown^99DCT']/label" value="Unknown"/><text xpath="xforms/group[@id='1']/select1[@bind='t']/label" value="Tea use"/><text xpath="xforms/group[@id='1']/select1[@bind='t']/hint" value="Question as to whether patient drinks tea"/><text xpath="xforms/group[@id='1']/select1[@bind='t']/item[@id='1065^Yes^99DCT']/label" value="Yes"/><text xpath="xforms/group[@id='1']/select1[@bind='t']/item[@id='1066^No^99DCT']/label" value="No"/><text xpath="xforms/group[@id='1']/select1[@bind='t']/item[@id='1067^Unknown^99DCT']/label" value="Unknown"/><text xpath="xforms/group[@id='1']/select1[@bind='drogas']/label" value="Current drug user"/><text xpath="xforms/group[@id='1']/select1[@bind='drogas']/hint" value="Taking drugs at present"/><text xpath="xforms/group[@id='1']/select1[@bind='drogas']/item[@id='1066^No^99DCT']/label" value="No"/><text xpath="xforms/group[@id='1']/select1[@bind='drogas']/item[@id='1065^Yes^99DCT']/label" value="Yes"/><text xpath="xforms/group[@id='1']/select1[@bind='drogas']/item[@id='1067^Unknown^99DCT']/label" value="Unknown"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/label" value="Smoking Status"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/item[@id='163200^Unknown if ever smoked^99DCT']/label" value="Unknown if ever smoked"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/item[@id='163199^Current every day smoker^99DCT']/label" value="Current every day smoker"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/item[@id='152807^Former Smoker^99DCT']/label" value="Former Smoker"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/item[@id='163196^Current light tobacco smoker^99DCT']/label" value="Current light tobacco smoker"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/item[@id='163195^Current heavy tobacco smoker^99DCT']/label" value="Current heavy tobacco smoker"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/item[@id='152722^Smoker^99DCT']/label" value="Smoker"/><text xpath="xforms/group[@id='1']/select1[@bind='tabaco_slash_cigarro']/item[@id='163197^Current some day smoker^99DCT']/label" value="Current some day smoker"/><text xpath="xforms/group[@id='1']/select1[@bind='alcohol']/label" value="Alcohol use status"/><text xpath="xforms/group[@id='1']/select1[@bind='alcohol']/hint" value="Whether the patient consumes alcohol or not"/><text xpath="xforms/group[@id='1']/select1[@bind='alcohol']/item[@id='159452^In the past^99DCT']/label" value="In the past"/><text xpath="xforms/group[@id='1']/select1[@bind='alcohol']/item[@id='159450^Currently^99DCT']/label" value="Currently"/><text xpath="xforms/group[@id='1']/select1[@bind='alcohol']/item[@id='1090^Never^99DCT']/label" value="Never"/><text xpath="xforms/group[@id='1']/input[@bind='antecedentes_heredofamiliares_otros']/label" value="Family history (Other)"/><text xpath="xforms/group[@id='1']/input[@bind='antecedentes_heredofamiliares_hija']/label" value="Family history (Daughter)"/><text 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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 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