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- <?xml version="1.0" encoding="UTF-8"?>
- <form id="38" name="Patient Medical History" version="3.0" uuid="65a283d3-5f4e-46e7-917a-085ee19e94cf" xmlns:openmrs="formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/38-1" xmlns:xd="http://schemas.microsoft.com/office/infopath/2003" xmlns:xf="http://www.w3.org/2002/xforms" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:jr="http://openrosa.org/javarosa">
- <header>
- <enterer/>
- <date_entered/>
- <session/>
- <uid/>
- </header>
- <patient>
- <patient.last_name openmrs_table="patient_name" openmrs_attribute="family_name"/>
- <patient.first_name openmrs_table="patient_name" openmrs_attribute="given_name"/>
- <patient.medical_record_number openmrs_table="patient_identifier" openmrs_attribute="identifier"/>
- <patient.patient_id openmrs_table="patient" openmrs_attribute="patient_id"/>
- </patient>
- <encounter>
- <encounter.encounter_datetime openmrs_table="encounter" openmrs_attribute="encounter_datetime">2013-04-02</encounter.encounter_datetime>
- <encounter.location_id openmrs_table="encounter" openmrs_attribute="location_id">3</encounter.location_id>
- <encounter.provider_id openmrs_table="encounter" openmrs_attribute="provider_id" provider_id_type="PROVIDER.ID">1</encounter.provider_id>
- </encounter>
- <obs openmrs_concept="1238^MEDICAL RECORD OBSERVATIONS^99DCT" openmrs_datatype="ZZ">
- <family_history_of_diabetes_mellitus openmrs_concept="140228^Family History of Diabetes Mellitus^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">1066^NO^99DCT</value>
- </family_history_of_diabetes_mellitus>
- <diabetes_mellitus openmrs_concept="119481^Diabetes Mellitus^99DCT" openmrs_datatype="CWE">
- <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">13/04/2013</value>
- </diagnosis_date>
- </diabetes_mellitus>
- <myocardial_infarction openmrs_concept="115432^Myocardial Infarction^99DCT" openmrs_datatype="ZZ">
- <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- </diagnosis_date>
- </myocardial_infarction>
- <cerebrovascular_accident openmrs_concept="111103^Cerebrovascular Accident^99DCT" openmrs_datatype="ZZ">
- <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- </diagnosis_date>
- </cerebrovascular_accident>
- <htn_hypertension openmrs_concept="117399^High blood pressure^99DCT" openmrs_datatype="ZZ">
- <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- </diagnosis_date>
- </htn_hypertension>
- <amputation openmrs_concept="161573^AMPUTATION^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">161571^YES - DM RELATED^99DCT</value>
- </amputation>
- <smoker openmrs_concept="152722^Smoker^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">1066^NO^99DCT</value>
- </smoker>
- <glucose_monitoring_at_home openmrs_concept="161580^GLUCOSE MONITORING AT HOME^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">1065^YES^99DCT</value>
- </glucose_monitoring_at_home>
- <number_of_minutes_of_exercise_per_day openmrs_concept="161262^Number of minutes of exercise per day^99DCT" openmrs_datatype="NM">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">45</value>
- </number_of_minutes_of_exercise_per_day>
- <free_text_comment openmrs_concept="161011^Free text comment^99DCT" openmrs_datatype="ST">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- </free_text_comment>
- <hypoglycemics openmrs_concept="161608^HYPOGLYCEMICS^99DCT" openmrs_datatype="CWE">insulin_isophane_beef-pork insulin_70_slash_30</hypoglycemics>
- <antihypersensitives openmrs_concept="161609^ANTIHYPERSENSITIVES^99DCT" openmrs_datatype="CWE">losartan enalapril</antihypersensitives>
- <side_effects openmrs_concept="161591^SIDE EFFECTS^99DCT" openmrs_datatype="ST">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- </side_effects>
- <adherence openmrs_concept="161581^ADHERENCE TO DRUGS^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">159405^Good^99DCT</value>
- </adherence>
- </obs>
- <problem_list openmrs_concept="1284^PROBLEM LIST^99DCT" openmrs_datatype="CWE">
- <problem_added openmrs_concept="6042^PROBLEM ADDED^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- </problem_added>
- <problem_resolved openmrs_concept="6097^PROBLEM RESOLVED^99DCT" openmrs_datatype="CWE" multiple="0">
- <date xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <time xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- <value xsi:nil="true" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"/>
- </problem_resolved>
- </problem_list>
- <other/></form>
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