API tools faq
paste
Advertisement
rolfnufable

Patient X form

rolfnufable
Oct 13th, 2015
45
0
Never
Add comment
Not a member of Pastebin yet? Sign Up, it unlocks many cool features!
text 56.15 KB | None | 0 0
raw download clone embed print report
  1. <?xml version="1.0" encoding="UTF-8"?>
  2. <PurcForm><Xform><xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" xmlns:jr="http://openrosa.org/javarosa" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
  3. <xf:model>
  4. <xf:instance>
  5. <patient name="Patient" id="0" description-template="${/patient/family_name}$ ${/patient/middle_name}$ ${/patient/given_name}$">
  6. <enterer/>
  7. <family_name/>
  8. <middle_name/>
  9. <given_name/>
  10. <birth_date/>
  11. <birth_date_estimated/>
  12. <identifier/>
  13. <patient_id/>
  14. <gender/>
  15. <degree/>
  16. <family_name2/>
  17. <family_name_prefix/>
  18. <family_name_suffix/>
  19. <prefix/>
  20. <location_id>2</location_id>
  21. <patient_identifier_type_id/>
  22. <person_attribute2/>
  23. <person_attribute3/>
  24. <person_attribute7/>
  25. <person_attribute6/>
  26. <person_attribute4/>
  27. <person_attribute1/>
  28. <person_address_address1/>
  29. <person_address_address2/>
  30. <person_address_city_village/>
  31. <person_address_state_province/>
  32. <person_address_postal_code/>
  33. <person_address_country/>
  34. <person_address_latitude/>
  35. <person_address_longitude/>
  36. <person_address_county_district/>
  37. <person_address_neighborhood_cell/>
  38. <person_address_region/>
  39. <person_address_subregion/>
  40. <person_address_township_division/>
  41. <other_identifiers>
  42. <other_identifier/>
  43. <other_identifier_type_id/>
  44. <other_identifier_location_id/>
  45. </other_identifiers>
  46. </patient>
  47. </xf:instance>
  48. <xf:bind id="family_name" nodeset="/patient/family_name" type="xsd:string" required="true()"/>
  49. <xf:bind id="middle_name" nodeset="/patient/middle_name" type="xsd:string"/>
  50. <xf:bind id="given_name" nodeset="/patient/given_name" type="xsd:string"/>
  51. <xf:bind id="birth_date" nodeset="/patient/birth_date" type="xsd:date"/>
  52. <xf:bind id="birth_date_estimated" nodeset="/patient/birth_date_estimated" type="xsd:boolean" readonly="true()" visible="false()"/>
  53. <xf:bind id="identifier" nodeset="/patient/identifier" type="xsd:string" required="true()"/>
  54. <xf:bind id="patient_id" nodeset="/patient/patient_id" type="xsd:int" readonly="true()" visible="false()"/>
  55. <xf:bind id="gender" nodeset="/patient/gender" type="xsd:string"/>
  56. <xf:bind id="degree" nodeset="/patient/degree" type="xsd:string" readonly="true()" visible="false()"/>
  57. <xf:bind id="family_name2" nodeset="/patient/family_name2" type="xsd:string" readonly="true()" visible="false()"/>
  58. <xf:bind id="family_name_prefix" nodeset="/patient/family_name_prefix" type="xsd:string" readonly="true()" visible="false()"/>
  59. <xf:bind id="family_name_suffix" nodeset="/patient/family_name_suffix" type="xsd:string"/>
  60. <xf:bind id="prefix" nodeset="/patient/prefix" type="xsd:string" readonly="true()" visible="false()"/>
  61. <xf:bind id="location_id" nodeset="/patient/location_id" type="xsd:string" visible="false()"/>
  62. <xf:bind id="patient_identifier_type_id" nodeset="/patient/patient_identifier_type_id" type="xsd:string" required="true()"/>
  63. <xf:bind id="person_attribute2" nodeset="/patient/person_attribute2" type="xsd:string" readonly="true()" visible="false()"/>
  64. <xf:bind id="person_attribute3" nodeset="/patient/person_attribute3" type="xsd:string" readonly="true()" visible="false()"/>
  65. <xf:bind id="person_attribute7" nodeset="/patient/person_attribute7" type="xsd:string"/>
  66. <xf:bind id="person_attribute6" nodeset="/patient/person_attribute6" type="xsd:string"/>
  67. <xf:bind id="person_attribute4" nodeset="/patient/person_attribute4" type="xsd:string"/>
  68. <xf:bind id="person_attribute1" nodeset="/patient/person_attribute1" type="xsd:string"/>
  69. <xf:bind id="person_address_address1" nodeset="/patient/person_address_address1" type="xsd:string" required="true()"/>
  70. <xf:bind id="person_address_address2" nodeset="/patient/person_address_address2" type="xsd:string" required="true()"/>
  71. <xf:bind id="person_address_city_village" nodeset="/patient/person_address_city_village" type="xsd:string" required="true()"/>
  72. <xf:bind id="person_address_state_province" nodeset="/patient/person_address_state_province" type="xsd:string" required="true()"/>
  73. <xf:bind id="person_address_postal_code" nodeset="/patient/person_address_postal_code" type="xsd:string"/>
  74. <xf:bind id="person_address_country" nodeset="/patient/person_address_country" type="xsd:string" required="true()"/>
  75. <xf:bind id="person_address_latitude" nodeset="/patient/person_address_latitude" type="xsd:string" required="true()"/>
  76. <xf:bind id="person_address_longitude" nodeset="/patient/person_address_longitude" type="xsd:string" required="true()"/>
  77. <xf:bind id="person_address_county_district" nodeset="/patient/person_address_county_district" type="xsd:string"/>
  78. <xf:bind id="person_address_neighborhood_cell" nodeset="/patient/person_address_neighborhood_cell" type="xsd:string"/>
  79. <xf:bind id="person_address_region" nodeset="/patient/person_address_region" type="xsd:string"/>
  80. <xf:bind id="person_address_subregion" nodeset="/patient/person_address_subregion" type="xsd:string"/>
  81. <xf:bind id="person_address_township_division" nodeset="/patient/person_address_township_division" type="xsd:string"/>
  82. <xf:bind id="other_identifiers" nodeset="/patient/other_identifiers"/>
  83. <xf:bind id="other_identifier" nodeset="/patient/other_identifiers/other_identifier" type="xsd:string"/>
  84. <xf:bind id="other_identifier_type_id" nodeset="/patient/other_identifiers/other_identifier_type_id" type="xsd:string"/>
  85. <xf:bind id="other_identifier_location_id" nodeset="/patient/other_identifiers/other_identifier_location_id" type="xsd:string"/>
  86. </xf:model>
  87. <xf:group id="1">
  88. <xf:label>Page1</xf:label>
  89. <xf:input bind="family_name">
  90. <xf:label>Family Name</xf:label>
  91. <xf:hint>The patient family name</xf:hint>
  92. </xf:input>
  93. <xf:input bind="middle_name">
  94. <xf:label>Middle Name</xf:label>
  95. <xf:hint>The patient middle name</xf:hint>
  96. </xf:input>
  97. <xf:input bind="given_name">
  98. <xf:label>Given Name</xf:label>
  99. <xf:hint>The patient given name</xf:hint>
  100. </xf:input>
  101. <xf:input bind="birth_date">
  102. <xf:label>Birth Date</xf:label>
  103. <xf:hint>The patient birth date</xf:hint>
  104. </xf:input>
  105. <xf:input bind="birth_date_estimated">
  106. <xf:label>Birth Date Estimated</xf:label>
  107. <xf:hint>Is the patient birth date estimated?</xf:hint>
  108. </xf:input>
  109. <xf:input bind="identifier">
  110. <xf:label>Identifier</xf:label>
  111. <xf:hint>The patient identifier</xf:hint>
  112. </xf:input>
  113. <xf:input bind="patient_id">
  114. <xf:label>Patient ID</xf:label>
  115. <xf:hint>The patient ID</xf:hint>
  116. </xf:input>
  117. <xf:select1 bind="gender">
  118. <xf:label>Gender</xf:label>
  119. <xf:hint>The patient's sex</xf:hint>
  120. <xf:item id="M">
  121. <xf:label>Male</xf:label>
  122. <xf:value>M</xf:value>
  123. </xf:item>
  124. <xf:item id="F">
  125. <xf:label>Female</xf:label>
  126. <xf:value>F</xf:value>
  127. </xf:item>
  128. </xf:select1>
  129. <xf:input bind="degree">
  130. <xf:label>Degree</xf:label>
  131. <xf:hint>The patient name degree</xf:hint>
  132. </xf:input>
  133. <xf:input bind="family_name2">
  134. <xf:label>Family Name 2</xf:label>
  135. <xf:hint>The patient second family name</xf:hint>
  136. </xf:input>
  137. <xf:input bind="family_name_prefix">
  138. <xf:label>Family Name Prefix</xf:label>
  139. <xf:hint>The patient family name prefix</xf:hint>
  140. </xf:input>
  141. <xf:input bind="family_name_suffix">
  142. <xf:label>Suffix</xf:label>
  143. <xf:hint>The patient family name suffix</xf:hint>
  144. </xf:input>
  145. <xf:input bind="prefix">
  146. <xf:label>Prefix</xf:label>
  147. <xf:hint>The patient name prefix</xf:hint>
  148. </xf:input>
  149. <xf:input bind="location_id">
  150. <xf:label>Location</xf:label>
  151. <xf:hint>The patient's location</xf:hint>
  152.  
  153.  
  154. </xf:input>
  155. <xf:select1 bind="patient_identifier_type_id">
  156. <xf:label>Identifier Type</xf:label>
  157. <xf:hint>The patient's identifier type</xf:hint>
  158. <xf:item id="2">
  159. <xf:label>Old Identification Number</xf:label>
  160. <xf:value>2</xf:value>
  161. </xf:item>
  162. <xf:item id="1">
  163. <xf:label>OpenMRS Identification Number</xf:label>
  164. <xf:value>1</xf:value>
  165. </xf:item>
  166. </xf:select1>
  167. <xf:input bind="person_attribute2">
  168. <xf:label>Birthplace</xf:label>
  169. <xf:hint>Location of persons birth</xf:hint>
  170. </xf:input>
  171. <xf:input bind="person_attribute3">
  172. <xf:label>Citizenship</xf:label>
  173. <xf:hint>Country of which this person is a member</xf:hint>
  174. </xf:input>
  175. <xf:select1 bind="person_attribute7">
  176. <xf:label>Health Center</xf:label>
  177. <xf:hint>Specific Location of this person's home health center.</xf:hint>
  178. <xf:item id="2">
  179. <xf:label>BSI [2]</xf:label>
  180. <xf:value>2</xf:value>
  181. </xf:item>
  182. <xf:item id="1">
  183. <xf:label>Unknown Location [1]</xf:label>
  184. <xf:value>1</xf:value>
  185. </xf:item>
  186. </xf:select1>
  187. <xf:input bind="person_attribute6">
  188. <xf:label>Health District</xf:label>
  189. <xf:hint>District/region in which this patient' home health center resides</xf:hint>
  190. </xf:input>
  191. <xf:input bind="person_attribute4">
  192. <xf:label>Mother's Name</xf:label>
  193. <xf:hint>First or last name of this person's mother</xf:hint>
  194. </xf:input>
  195. <xf:input bind="person_attribute1">
  196. <xf:label>Race</xf:label>
  197. <xf:hint>Group of persons related by common descent or heredity</xf:hint>
  198. </xf:input>
  199. <xf:input bind="person_address_address1">
  200. <xf:label>Address</xf:label>
  201. </xf:input>
  202. <xf:select1 bind="person_address_address2">
  203. <xf:label>Marital Status</xf:label>
  204. <xf:item id="single"><xf:label>Single</xf:label><xf:value>single</xf:value></xf:item><xf:item id="married"><xf:label>Married</xf:label><xf:value>married</xf:value></xf:item><xf:item id="widowed"><xf:label>Widowed</xf:label><xf:value>widowed</xf:value></xf:item></xf:select1>
  205. <xf:input bind="person_address_city_village">
  206. <xf:label>E-Mail</xf:label>
  207. </xf:input>
  208. <xf:input bind="person_address_state_province">
  209. <xf:label>Contact Number</xf:label>
  210. </xf:input>
  211. <xf:input bind="person_address_postal_code">
  212. <xf:label>Postal Code</xf:label>
  213. </xf:input>
  214. <xf:select1 bind="person_address_country">
  215. <xf:label>Type of Patient</xf:label>
  216. <xf:item id="walk in"><xf:label>Walk in</xf:label><xf:value>walk in</xf:value></xf:item><xf:item id="referred by doctor"><xf:label>Referred by Doctor</xf:label><xf:value>referred by doctor</xf:value></xf:item><xf:item id="referred by company"><xf:label>Referred By Company</xf:label><xf:value>referred by company</xf:value></xf:item></xf:select1>
  217. <xf:input bind="person_address_latitude">
  218. <xf:label>Hmo Vendor</xf:label>
  219. </xf:input>
  220. <xf:input bind="person_address_longitude">
  221. <xf:label>Hmo Number</xf:label>
  222. </xf:input>
  223. <xf:input bind="person_address_county_district">
  224. <xf:label>County/District</xf:label>
  225. </xf:input>
  226. <xf:input bind="person_address_neighborhood_cell">
  227. <xf:label>Neighborhood Cell</xf:label>
  228. </xf:input>
  229. <xf:input bind="person_address_region">
  230. <xf:label>Region</xf:label>
  231. </xf:input>
  232. <xf:input bind="person_address_subregion">
  233. <xf:label>Sub Region</xf:label>
  234. </xf:input>
  235. <xf:input bind="person_address_township_division">
  236. <xf:label>Township/Division</xf:label>
  237. </xf:input>
  238. <xf:group id="other_identifiers">
  239. <xf:label>Other dentifiers</xf:label>
  240. <xf:repeat bind="other_identifiers">
  241. <xf:input bind="other_identifier">
  242. <xf:label>Identifier</xf:label>
  243. <xf:hint>The patient's other identifier value</xf:hint>
  244. </xf:input>
  245. <xf:select1 bind="other_identifier_type_id">
  246. <xf:label>Identifier Type</xf:label>
  247. <xf:hint>The patient's other identifier type</xf:hint>
  248. <xf:item id="2">
  249. <xf:label>Old Identification Number</xf:label>
  250. <xf:value>2</xf:value>
  251. </xf:item>
  252. <xf:item id="1">
  253. <xf:label>OpenMRS Identification Number</xf:label>
  254. <xf:value>1</xf:value>
  255. </xf:item>
  256. </xf:select1>
  257. <xf:select1 bind="other_identifier_location_id">
  258. <xf:label>Identifier Location</xf:label>
  259. <xf:hint>The patient's other identifier location</xf:hint>
  260. <xf:item id="2">
  261. <xf:label>BSI [2]</xf:label>
  262. <xf:value>2</xf:value>
  263. </xf:item>
  264. <xf:item id="1">
  265. <xf:label>Unknown Location [1]</xf:label>
  266. <xf:value>1</xf:value>
  267. </xf:item>
  268. </xf:select1>
  269. </xf:repeat>
  270. </xf:group>
  271. </xf:group>
  272. </xf:xforms></Xform><Layout><Form id="0"><Page Text="Page1" fontWeight="normal" fontSize="16px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, Sans-Serif" Binding="Page1" Width="900px" Height="1693px" backgroundColor=""><Item WidgetType="Label" Text="Middle Name" HelpText="The patient middle name" Binding="middle_name" Left="338px" Top="129px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="The patient middle name" Binding="middle_name" Left="449px" Top="123px" Width="126px" Height="25px" TabIndex="2" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="The patient given name" Binding="given_name" Left="706px" Top="126px" Width="167px" Height="25px" TabIndex="3" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Given Name" HelpText="The patient given name" Binding="given_name" Left="595px" Top="127px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Identifier" HelpText="The patient identifier" Binding="identifier" Left="0px" Top="59px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="The patient identifier" Binding="identifier" Left="79px" Top="59px" Width="200px" Height="25px" TabIndex="6" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="The patient family name" Binding="family_name" Left="107px" Top="126px" Width="200px" Height="25px" TabIndex="1" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Family Name" HelpText="The patient family name" Binding="family_name" Left="0px" Top="126px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Identifier Type" HelpText="The patient's identifier type" Binding="patient_identifier_type_id" Left="293px" Top="61px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="ListBox" HelpText="The patient's identifier type" Binding="patient_identifier_type_id" Left="418px" Top="61px" Width="200px" Height="28px" TabIndex="14" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Type of Patient" HelpText="Type of Patient" Binding="person_address_country" Left="640px" Top="64px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="ListBox" HelpText="Type of Patient" Binding="person_address_country" Left="768px" Top="60px" Width="126px" Height="26px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Gender" HelpText="The patient's sex" Binding="gender" Left="0px" Top="237px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="ListBox" HelpText="The patient's sex" Binding="gender" Left="64px" Top="237px" Width="200px" Height="25px" TabIndex="7" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="The patient family name suffix" Binding="family_name_suffix" Left="333px" Top="238px" Width="200px" Height="25px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Address" HelpText="Address" Binding="person_address_address1" Left="0px" Top="178px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="Address" Binding="person_address_address1" Left="68px" Top="176px" Width="788px" Height="25px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Birth Date" HelpText="The patient birth date" Binding="birth_date" Left="553px" Top="239px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="DatePicker" HelpText="The patient birth date" Binding="birth_date" Left="642px" Top="237px" Width="200px" Height="26px" TabIndex="4" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Marital Status" HelpText="Marital Status" Binding="person_address_address2" Left="0px" Top="287px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="ListBox" HelpText="Marital Status" Binding="person_address_address2" Left="120px" Top="287px" Width="200px" Height="24px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="E-Mail" HelpText="E-Mail" Binding="person_address_city_village" Left="0px" Top="330px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="E-Mail" Binding="person_address_city_village" Left="55px" Top="330px" Width="200px" Height="25px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="Postal Code" Binding="person_address_postal_code" Left="498px" Top="288px" Width="200px" Height="25px" TabIndex="25" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Contact Number" HelpText="Contact Number" Binding="person_address_state_province" Left="282px" Top="333px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="Contact Number" Binding="person_address_state_province" Left="420px" Top="331px" Width="164px" Height="27px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Hmo Vendor" HelpText="Hmo Vendor" Binding="person_address_latitude" Left="0px" Top="373px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="Hmo Vendor" Binding="person_address_latitude" Left="104px" Top="373px" Width="200px" Height="25px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Hmo Number" HelpText="Hmo Number" Binding="person_address_longitude" Left="329px" Top="377px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="TextBox" HelpText="Hmo Number" Binding="person_address_longitude" Left="442px" Top="377px" Width="200px" Height="22px" TabIndex="72" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Other dentifiers" HelpText="Other dentifiers" Binding="other_identifiers" Left="4px" Top="412px" TabIndex="0" fontWeight="bold" fontStyle="italic" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Identifier" HelpText="The patient's other identifier value" Binding="other_identifier" Left="19px" Top="437px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif" textDecoration="underline"/><Item WidgetType="Label" Text="Identifier Type" HelpText="The patient's other identifier type" Binding="other_identifier_type_id" Left="229px" Top="437px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif" textDecoration="underline"/><Item WidgetType="Label" Text="Identifier Location" HelpText="The patient's other identifier location" Binding="other_identifier_location_id" Left="439px" Top="437px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif" textDecoration="underline"/><Item WidgetType="GroupBox" HelpText="Other dentifiers" Binding="other_identifiers" Left="12px" Top="468px" Width="630px" Height="100px" TabIndex="34" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif" borderWidth="1px" borderColor="rgb(143, 171, 199)" Repeated="1"><Item WidgetType="TextBox" HelpText="The patient's other identifier value" Binding="other_identifier" Left="10px" Top="10px" Width="200px" Height="25px" TabIndex="1" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="ListBox" HelpText="The patient's other identifier location" Binding="other_identifier_location_id" Left="420px" Top="10px" Width="200px" Height="25px" TabIndex="3" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="ListBox" HelpText="The patient's other identifier type" Binding="other_identifier_type_id" Left="214px" Top="11px" Width="200px" Height="25px" TabIndex="2" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Button" Text="Add New" HelpText="addnew" Binding="addnew" Left="10px" Top="55px" Width="120px" Height="30px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/></Item><Item WidgetType="Button" Text="Submit" HelpText="submit" Binding="submit" Left="27px" Top="584px" Width="70px" Height="30px" TabIndex="35" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Button" Text="Close" HelpText="cancel" Binding="cancel" Left="227px" Top="582px" Width="70px" Height="36px" TabIndex="36" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Postal Code" HelpText="Postal Code" Binding="person_address_postal_code" Left="395px" Top="287px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/><Item WidgetType="Label" Text="Suffix" HelpText="Suffix" Binding="suffix" Left="280px" Top="237px" TabIndex="0" fontSize="16px" fontFamily="Verdana,&quot;Lucida Grande&quot;,&quot;Trebuchet MS&quot;,Arial,sans-serif"/></Page></Form></Layout><Language><LanguageText lang="en"><xform id="0"><text xpath="xforms/model/instance/patient[@name]" value="Patient"/><text xpath="xforms/group[@id='1']/label" value="Page1"/><text xpath="xforms/group[@id='1']/input[@bind='family_name']/label" value="Family Name"/><text xpath="xforms/group[@id='1']/input[@bind='family_name']/hint" value="The patient family name"/><text xpath="xforms/group[@id='1']/input[@bind='middle_name']/label" value="Middle Name"/><text xpath="xforms/group[@id='1']/input[@bind='middle_name']/hint" value="The patient middle name"/><text xpath="xforms/group[@id='1']/input[@bind='given_name']/label" value="Given Name"/><text xpath="xforms/group[@id='1']/input[@bind='given_name']/hint" value="The patient given name"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date']/label" value="Birth Date"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date']/hint" value="The patient birth date"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date_estimated']/label" value="Birth Date Estimated"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date_estimated']/hint" value="Is the patient birth date estimated?"/><text xpath="xforms/group[@id='1']/input[@bind='identifier']/label" value="Identifier"/><text xpath="xforms/group[@id='1']/input[@bind='identifier']/hint" value="The patient identifier"/><text xpath="xforms/group[@id='1']/input[@bind='patient_id']/label" value="Patient ID"/><text xpath="xforms/group[@id='1']/input[@bind='patient_id']/hint" value="The patient ID"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/label" value="Gender"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/hint" value="The patient's sex"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/item[@id='M']/label" value="Male"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/item[@id='F']/label" value="Female"/><text xpath="xforms/group[@id='1']/input[@bind='degree']/label" value="Degree"/><text xpath="xforms/group[@id='1']/input[@bind='degree']/hint" value="The patient name degree"/><text xpath="xforms/group[@id='1']/input[@bind='family_name2']/label" value="Family Name 2"/><text xpath="xforms/group[@id='1']/input[@bind='family_name2']/hint" value="The patient second family name"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_prefix']/label" value="Family Name Prefix"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_prefix']/hint" value="The patient family name prefix"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_suffix']/label" value="Suffix"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_suffix']/hint" value="The patient family name suffix"/><text xpath="xforms/group[@id='1']/input[@bind='prefix']/label" value="Prefix"/><text xpath="xforms/group[@id='1']/input[@bind='prefix']/hint" value="The patient name prefix"/><text xpath="xforms/group[@id='1']/input[@bind='location_id']/label" value="Location"/><text xpath="xforms/group[@id='1']/input[@bind='location_id']/hint" value="The patient's location"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/label" value="Identifier Type"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/hint" value="The patient's identifier type"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/item[@id='2']/label" value="Old Identification Number"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/item[@id='1']/label" value="OpenMRS Identification Number"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute2']/label" value="Birthplace"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute2']/hint" value="Location of persons birth"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute3']/label" value="Citizenship"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute3']/hint" value="Country of which this person is a member"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute7']/label" value="Health Center"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute7']/hint" value="Specific Location of this person's home health center."/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute7']/item[@id='2']/label" value="BSI [2]"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute7']/item[@id='1']/label" value="Unknown Location [1]"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute6']/label" value="Health District"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute6']/hint" value="District/region in which this patient' home health center resides"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute4']/label" value="Mother's Name"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute4']/hint" value="First or last name of this person's mother"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute1']/label" value="Race"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute1']/hint" value="Group of persons related by common descent or heredity"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_address1']/label" value="Address"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_address2']/label" value="Marital Status"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_address2']/item[@id='single']/label" value="Single"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_address2']/item[@id='married']/label" value="Married"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_address2']/item[@id='widowed']/label" value="Widowed"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_city_village']/label" value="E-Mail"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_state_province']/label" value="Contact Number"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_postal_code']/label" value="Postal Code"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_country']/label" value="Type of Patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_country']/item[@id='walk in']/label" value="Walk in"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_country']/item[@id='referred by doctor']/label" value="Referred by Doctor"/><text xpath="xforms/group[@id='1']/select1[@bind='person_address_country']/item[@id='referred by company']/label" value="Referred By Company"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_latitude']/label" value="Hmo Vendor"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_longitude']/label" value="Hmo Number"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_county_district']/label" value="County/District"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_neighborhood_cell']/label" value="Neighborhood Cell"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_region']/label" value="Region"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_subregion']/label" value="Sub Region"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_township_division']/label" value="Township/Division"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/label" value="Other dentifiers"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/input[@bind='other_identifier']/label" value="Identifier"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/input[@bind='other_identifier']/hint" value="The patient's other identifier value"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/label" value="Identifier Type"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/hint" value="The patient's other identifier type"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/item[@id='2']/label" value="Old Identification Number"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/item[@id='1']/label" value="OpenMRS Identification Number"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_location_id']/label" value="Identifier Location"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_location_id']/hint" value="The patient's other identifier location"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_location_id']/item[@id='2']/label" value="BSI [2]"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_location_id']/item[@id='1']/label" value="Unknown Location [1]"/></xform><Form id="0"><text xpath="Form/Page[@Binding='Page1'][@Text]" value="Page1"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='Label'][@Text]" value="Middle Name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='Label'][@HelpText]" value="The patient middle name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='Label'][@Top]" value="129px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='Label'][@Left]" value="338px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@HelpText]" value="The patient middle name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@Top]" value="123px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@Left]" value="449px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@Width]" value="126px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='TextBox'][@HelpText]" value="The patient given name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='TextBox'][@Top]" value="126px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='TextBox'][@Left]" value="706px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='TextBox'][@Width]" value="167px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='Label'][@Text]" value="Given Name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='Label'][@HelpText]" value="The patient given name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='Label'][@Top]" value="127px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='given_name' and @WidgetType='Label'][@Left]" value="595px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='Label'][@Text]" value="Identifier"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='Label'][@HelpText]" value="The patient identifier"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='Label'][@Top]" value="59px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='TextBox'][@HelpText]" value="The patient identifier"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Top]" value="59px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Left]" value="79px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='TextBox'][@HelpText]" value="The patient family name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='TextBox'][@Top]" value="126px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='TextBox'][@Left]" value="107px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='Label'][@Text]" value="Family Name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='Label'][@HelpText]" value="The patient family name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='Label'][@Top]" value="126px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@Text]" value="Identifier Type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@HelpText]" value="The patient's identifier type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@Top]" value="61px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@Left]" value="293px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='ListBox'][@HelpText]" value="The patient's identifier type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='ListBox'][@Top]" value="61px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='ListBox'][@Left]" value="418px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='patient_identifier_type_id' and @WidgetType='ListBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='Label'][@Text]" value="Type of Patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='Label'][@HelpText]" value="Type of Patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='Label'][@Top]" value="64px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='Label'][@Left]" value="640px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='ListBox'][@HelpText]" value="Type of Patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='ListBox'][@Top]" value="60px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='ListBox'][@Left]" value="768px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_country' and @WidgetType='ListBox'][@Width]" value="126px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='Label'][@Text]" value="Gender"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='Label'][@HelpText]" value="The patient's sex"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='Label'][@Top]" value="237px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='ListBox'][@HelpText]" value="The patient's sex"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='ListBox'][@Top]" value="237px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='ListBox'][@Left]" value="64px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='gender' and @WidgetType='ListBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name_suffix' and @WidgetType='TextBox'][@HelpText]" value="The patient family name suffix"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name_suffix' and @WidgetType='TextBox'][@Top]" value="238px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name_suffix' and @WidgetType='TextBox'][@Left]" value="333px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='family_name_suffix' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='Label'][@Text]" value="Address"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='Label'][@HelpText]" value="Address"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='Label'][@Top]" value="178px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='TextBox'][@HelpText]" value="Address"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='TextBox'][@Top]" value="176px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='TextBox'][@Left]" value="68px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address1' and @WidgetType='TextBox'][@Width]" value="788px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='Label'][@Text]" value="Birth Date"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='Label'][@HelpText]" value="The patient birth date"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='Label'][@Top]" value="239px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='Label'][@Left]" value="553px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@HelpText]" value="The patient birth date"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@Top]" value="237px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@Left]" value="642px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='Label'][@Text]" value="Marital Status"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='Label'][@HelpText]" value="Marital Status"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='Label'][@Top]" value="287px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='ListBox'][@HelpText]" value="Marital Status"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='ListBox'][@Top]" value="287px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='ListBox'][@Left]" value="120px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_address2' and @WidgetType='ListBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='Label'][@Text]" value="E-Mail"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='Label'][@HelpText]" value="E-Mail"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='Label'][@Top]" value="330px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='TextBox'][@HelpText]" value="E-Mail"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='TextBox'][@Top]" value="330px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='TextBox'][@Left]" value="55px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_city_village' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='TextBox'][@HelpText]" value="Postal Code"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='TextBox'][@Top]" value="288px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='TextBox'][@Left]" value="498px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='Label'][@Text]" value="Contact Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='Label'][@HelpText]" value="Contact Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='Label'][@Top]" value="333px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='Label'][@Left]" value="282px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='TextBox'][@HelpText]" value="Contact Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='TextBox'][@Top]" value="331px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='TextBox'][@Left]" value="420px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_state_province' and @WidgetType='TextBox'][@Width]" value="164px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='Label'][@Text]" value="Hmo Vendor"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='Label'][@HelpText]" value="Hmo Vendor"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='Label'][@Top]" value="373px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='TextBox'][@HelpText]" value="Hmo Vendor"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='TextBox'][@Top]" value="373px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='TextBox'][@Left]" value="104px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_latitude' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='Label'][@Text]" value="Hmo Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='Label'][@HelpText]" value="Hmo Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='Label'][@Top]" value="377px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='Label'][@Left]" value="329px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='TextBox'][@HelpText]" value="Hmo Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='TextBox'][@Top]" value="377px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='TextBox'][@Left]" value="442px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_longitude' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='Label'][@Text]" value="Other dentifiers"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='Label'][@HelpText]" value="Other dentifiers"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='Label'][@Top]" value="412px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='Label'][@Left]" value="4px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier' and @WidgetType='Label'][@Text]" value="Identifier"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier' and @WidgetType='Label'][@HelpText]" value="The patient's other identifier value"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier' and @WidgetType='Label'][@Top]" value="437px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_type_id' and @WidgetType='Label'][@Text]" value="Identifier Type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_type_id' and @WidgetType='Label'][@HelpText]" value="The patient's other identifier type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_type_id' and @WidgetType='Label'][@Top]" value="437px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_type_id' and @WidgetType='Label'][@Left]" value="229px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_location_id' and @WidgetType='Label'][@Text]" value="Identifier Location"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_location_id' and @WidgetType='Label'][@HelpText]" value="The patient's other identifier location"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_location_id' and @WidgetType='Label'][@Top]" value="437px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifier_location_id' and @WidgetType='Label'][@Left]" value="439px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox'][@HelpText]" value="Other dentifiers"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox'][@Top]" value="468px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox'][@Left]" value="12px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox'][@Width]" value="630px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier' and @WidgetType='TextBox'][@HelpText]" value="The patient's other identifier value"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier' and @WidgetType='TextBox'][@Top]" value="10px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier' and @WidgetType='TextBox'][@Left]" value="10px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_location_id' and @WidgetType='ListBox'][@HelpText]" value="The patient's other identifier location"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_location_id' and @WidgetType='ListBox'][@Top]" value="10px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_location_id' and @WidgetType='ListBox'][@Left]" value="420px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_location_id' and @WidgetType='ListBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_type_id' and @WidgetType='ListBox'][@HelpText]" value="The patient's other identifier type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_type_id' and @WidgetType='ListBox'][@Top]" value="11px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_type_id' and @WidgetType='ListBox'][@Left]" value="214px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='other_identifier_type_id' and @WidgetType='ListBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='addnew' and @WidgetType='Button'][@Text]" value="Add New"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='addnew' and @WidgetType='Button'][@HelpText]" value="addnew"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='addnew' and @WidgetType='Button'][@Top]" value="55px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='addnew' and @WidgetType='Button'][@Left]" value="10px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='other_identifiers' and @WidgetType='GroupBox']/Item[@Binding='addnew' and @WidgetType='Button'][@Width]" value="120px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Text]" value="Submit"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@HelpText]" value="submit"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Top]" value="584px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Left]" value="27px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Width]" value="70px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@Text]" value="Close"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@HelpText]" value="cancel"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@Top]" value="582px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@Left]" value="227px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@Width]" value="70px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='Label'][@Text]" value="Postal Code"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='Label'][@HelpText]" value="Postal Code"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='Label'][@Top]" value="287px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='person_address_postal_code' and @WidgetType='Label'][@Left]" value="395px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='suffix' and @WidgetType='Label'][@Text]" value="Suffix"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='suffix' and @WidgetType='Label'][@HelpText]" value="Suffix"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='suffix' and @WidgetType='Label'][@Top]" value="237px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='suffix' and @WidgetType='Label'][@Left]" value="280px"/></Form></LanguageText></Language></PurcForm>
Advertisement
Add Comment
Please, Sign In to add comment
Advertisement
Public Pastes
Advertisement
We use cookies for various purposes including analytics. By continuing to use Pastebin, you agree to our use of cookies as described in the Cookies Policy.  OK, I Understand
Not a member of Pastebin yet?
Sign Up, it unlocks many cool features!