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JoeSeff

Physical Exam Form

JoeSeff
Apr 2nd, 2013
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  1. <?xml version="1.0" encoding="UTF-8"?>
  2. <xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" xmlns:xsd="http://www.w3.org/2001/XMLSchema" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:jr="http://openrosa.org/javarosa">
  3.   <xf:model id="openmrs_model">
  4.     <xf:instance id="openmrs_model_instance">
  5.       <form id="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">
  6.   <header>
  7.     <enterer/>
  8.     <date_entered/>
  9.     <session/>
  10.     <uid/>
  11.   </header>
  12.   <patient>
  13.     <patient.last_name openmrs_table="patient_name" openmrs_attribute="family_name"/>
  14.     <patient.first_name openmrs_table="patient_name" openmrs_attribute="given_name"/>
  15.     <patient.medical_record_number openmrs_table="patient_identifier" openmrs_attribute="identifier"/>
  16.     <patient.patient_id openmrs_table="patient" openmrs_attribute="patient_id"/>
  17.   </patient>
  18.   <encounter>
  19.     <encounter.encounter_datetime openmrs_table="encounter" openmrs_attribute="encounter_datetime">'today()'</encounter.encounter_datetime>
  20.     <encounter.location_id openmrs_table="encounter" openmrs_attribute="location_id"/>
  21.     <encounter.provider_id openmrs_table="encounter" openmrs_attribute="provider_id" provider_id_type="PROVIDER.ID"/>
  22.   </encounter>
  23.   <obs openmrs_concept="1238^MEDICAL RECORD OBSERVATIONS^99DCT" openmrs_datatype="ZZ">
  24.     <family_history_of_diabetes_mellitus openmrs_concept="140228^Family History of Diabetes Mellitus^99DCT" openmrs_datatype="CWE" multiple="0">
  25.         <date xsi:nil="true"/>
  26.         <time xsi:nil="true"/>
  27.         <value xsi:nil="true"/>
  28.     </family_history_of_diabetes_mellitus>
  29.     <diabetes_mellitus openmrs_concept="119481^Diabetes Mellitus^99DCT" openmrs_datatype="CWE">
  30.       <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
  31.             <date xsi:nil="true"/>
  32.             <time xsi:nil="true"/>
  33.             <value xsi:nil="true"/>
  34.       </diagnosis_date>
  35.     </diabetes_mellitus>
  36.     <myocardial_infarction openmrs_concept="115432^Myocardial Infarction^99DCT" openmrs_datatype="ZZ">
  37.       <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
  38.             <date xsi:nil="true"/>
  39.             <time xsi:nil="true"/>
  40.             <value xsi:nil="true"/>
  41.       </diagnosis_date>
  42.     </myocardial_infarction>
  43.     <cerebrovascular_accident openmrs_concept="111103^Cerebrovascular Accident^99DCT" openmrs_datatype="ZZ">
  44.       <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
  45.             <date xsi:nil="true"/>
  46.             <time xsi:nil="true"/>
  47.             <value xsi:nil="true"/>
  48.       </diagnosis_date>
  49.     </cerebrovascular_accident>
  50.     <htn_hypertension openmrs_concept="117399^High blood pressure^99DCT" openmrs_datatype="ZZ">
  51.       <diagnosis_date openmrs_concept="159948^Diagnosis date^99DCT" openmrs_datatype="DT">
  52.             <date xsi:nil="true"/>
  53.             <time xsi:nil="true"/>
  54.             <value xsi:nil="true"/>
  55.       </diagnosis_date>
  56.     </htn_hypertension>
  57.     <amputation openmrs_concept="161573^AMPUTATION^99DCT" openmrs_datatype="CWE" multiple="0">
  58.         <date xsi:nil="true"/>
  59.         <time xsi:nil="true"/>
  60.         <value xsi:nil="true"/>
  61.     </amputation>
  62.     <smoker openmrs_concept="152722^Smoker^99DCT" openmrs_datatype="CWE" multiple="0">
  63.         <date xsi:nil="true"/>
  64.         <time xsi:nil="true"/>
  65.         <value xsi:nil="true"/>
  66.     </smoker>
  67.     <glucose_monitoring_at_home openmrs_concept="161580^GLUCOSE MONITORING AT HOME^99DCT" openmrs_datatype="CWE" multiple="0">
  68.         <date xsi:nil="true"/>
  69.         <time xsi:nil="true"/>
  70.         <value xsi:nil="true"/>
  71.     </glucose_monitoring_at_home>
  72.     <number_of_minutes_of_exercise_per_day openmrs_concept="161262^Number of minutes of exercise per day^99DCT" openmrs_datatype="NM">
  73.         <date xsi:nil="true"/>
  74.         <time xsi:nil="true"/>
  75.         <value xsi:nil="true"/>
  76.     </number_of_minutes_of_exercise_per_day>
  77.     <free_text_comment openmrs_concept="161011^Free text comment^99DCT" openmrs_datatype="ST">
  78.         <date xsi:nil="true"/>
  79.         <time xsi:nil="true"/>
  80.         <value xsi:nil="true"/>
  81.     </free_text_comment>
  82.     <hypoglycemics openmrs_concept="161608^HYPOGLYCEMICS^99DCT" openmrs_datatype="CWE"/>
  83.     <antihypersensitives openmrs_concept="161609^ANTIHYPERSENSITIVES^99DCT" openmrs_datatype="CWE"/>
  84.     <side_effects openmrs_concept="161591^SIDE EFFECTS^99DCT" openmrs_datatype="ST">
  85.         <date xsi:nil="true"/>
  86.         <time xsi:nil="true"/>
  87.         <value xsi:nil="true"/>
  88.     </side_effects>
  89.     <adherence openmrs_concept="161581^ADHERENCE TO DRUGS^99DCT" openmrs_datatype="CWE" multiple="0">
  90.         <date xsi:nil="true"/>
  91.         <time xsi:nil="true"/>
  92.         <value xsi:nil="true"/>
  93.     </adherence>
  94.   </obs>
  95.   <problem_list openmrs_concept="1284^PROBLEM LIST^99DCT" openmrs_datatype="CWE">
  96.     <problem_added openmrs_concept="6042^PROBLEM ADDED^99DCT" openmrs_datatype="CWE" multiple="0">
  97.         <date xsi:nil="true"/>
  98.         <time xsi:nil="true"/>
  99.         <value xsi:nil="true"/>
  100.     </problem_added>
  101.     <problem_resolved openmrs_concept="6097^PROBLEM RESOLVED^99DCT" openmrs_datatype="CWE" multiple="0">
  102.         <date xsi:nil="true"/>
  103.         <time xsi:nil="true"/>
  104.         <value xsi:nil="true"/>
  105.     </problem_resolved>
  106.   </problem_list>
  107.   <other/></form>
  108.     </xf:instance>
  109.     <xf:bind id="patient.last_name" nodeset="/form/patient/patient.last_name" type="xsd:string" locked="true()"/>
  110.     <xf:bind id="patient.first_name" nodeset="/form/patient/patient.first_name" type="xsd:string" locked="true()"/>
  111.     <xf:bind id="patient.medical_record_number" nodeset="/form/patient/patient.medical_record_number" type="xsd:string" locked="true()" jr:preload="patient" jr:preloadParams="patientIdentifier"/>
  112.     <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"/>
  113.     <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()"/>
  114.     <xf:bind id="encounter.location_id" nodeset="/form/encounter/encounter.location_id" type="xsd:string" required="true()"/>
  115.     <xf:bind id="encounter.provider_id" nodeset="/form/encounter/encounter.provider_id" type="xsd:string" required="true()"/>
  116.     <xf:bind id="amputation" nodeset="/form/obs/amputation/value" type="xsd:string"/><xf:bind id="side_effects" nodeset="/form/obs/side_effects/value" type="xsd:string"/><xf:bind id="adherence" nodeset="/form/obs/adherence/value" type="xsd:string"/><xf:bind id="problem_added" nodeset="/form/problem_list/problem_added"/><xf:bind id="problem_resolved" nodeset="/form/problem_list/problem_resolved"/><xf:bind id="family_history_of_diabetes_mellitus" nodeset="/form/obs/family_history_of_diabetes_mellitus/value" type="xsd:string"/>
  117.     <xf:bind id="diabetes_mellitus" nodeset="/form/obs/diabetes_mellitus" type="xsd:string"/>
  118.     <xf:bind id="diagnosis_date" nodeset="/form/obs/diabetes_mellitus/diagnosis_date/value" type="xsd:string"/>
  119.     <xf:bind id="myocardial_infarction" nodeset="/form/obs/myocardial_infarction"/>
  120.     <xf:bind id="myocardial_infarction_diagnosis_date" nodeset="/form/obs/myocardial_infarction/diagnosis_date/value" type="xsd:string"/>
  121.     <xf:bind id="cerebrovascular_accident" nodeset="/form/obs/cerebrovascular_accident"/>
  122.     <xf:bind id="cerebrovascular_accident_diagnosis_date" nodeset="/form/obs/cerebrovascular_accident/diagnosis_date/value" type="xsd:string"/>
  123.     <xf:bind id="htn_hypertension" nodeset="/form/obs/htn_hypertension"/>
  124.     <xf:bind id="htn_hypertension_diagnosis_date" nodeset="/form/obs/htn_hypertension/diagnosis_date/value" type="xsd:string"/>
  125.    
  126.     <xf:bind id="smoker" nodeset="/form/obs/smoker/value" type="xsd:string"/>
  127.     <xf:bind id="number_of_minutes_of_exercise_per_day" nodeset="/form/obs/number_of_minutes_of_exercise_per_day/value" type="xsd:decimal"/><xf:bind id="free_text_comment" nodeset="/form/obs/free_text_comment/value" type="xsd:string"/><xf:bind id="hypoglycemics" nodeset="/form/obs/hypoglycemics" type="xsd:string"/><xf:bind id="antihypersensitives" nodeset="/form/obs/antihypersensitives" type="xsd:string"/><xf:bind id="glucose_monitoring_at_home" nodeset="/form/obs/glucose_monitoring_at_home/value" type="xsd:string"/>
  128.    
  129.    
  130.    
  131.     <xf:bind id="insulin_70_slash_30" nodeset="/form/obs/hypoglycemics/insulin_70_slash_30/value"/>
  132.     <xf:bind id="metformin" nodeset="/form/obs/hypoglycemics/metformin/value"/>
  133.     <xf:bind id="insulin_isophane_beef-pork" nodeset="/form/obs/hypoglycemics/insulin_isophane_beef-pork/value"/>
  134.     <xf:bind id="insulin_lente" nodeset="/form/obs/hypoglycemics/insulin_lente/value"/>
  135.     <xf:bind id="glyburide" nodeset="/form/obs/hypoglycemics/glyburide/value"/>
  136.    
  137.     <xf:bind id="enalapril" nodeset="/form/obs/antihypersensitives/enalapril/value"/>
  138.     <xf:bind id="losartan" nodeset="/form/obs/antihypersensitives/losartan/value"/>
  139.     <xf:bind id="atenolol" nodeset="/form/obs/antihypersensitives/atenolol/value"/>
  140.     <xf:bind id="furosemide" nodeset="/form/obs/antihypersensitives/furosemide/value"/>
  141.     <xf:bind id="nifedipine" nodeset="/form/obs/antihypersensitives/nifedipine/value"/>
  142.    
  143.    
  144.    
  145.    
  146.     <xf:bind id="problem_list_problem_added_value" nodeset="/form/problem_list/problem_added/value" type="xsd:string"/>
  147.     <xf:bind id="problem_list_problem_resolved_value" nodeset="/form/problem_list/problem_resolved/value" type="xsd:string"/>
  148.   </xf:model>
  149.   <xf:group id="1">
  150.     <xf:label>Page1</xf:label>
  151.     <xf:input bind="patient.last_name">
  152.       <xf:label>LAST NAME</xf:label>
  153.     </xf:input>
  154.     <xf:input bind="patient.first_name">
  155.       <xf:label>FIRST NAME</xf:label>
  156.     </xf:input>
  157.     <xf:input bind="patient.medical_record_number">
  158.       <xf:label>MEDICAL RECORD NUMBER</xf:label>
  159.     </xf:input>
  160.     <xf:input bind="patient.patient_id">
  161.       <xf:label>PATIENT ID</xf:label>
  162.     </xf:input>
  163.     <xf:input bind="encounter.encounter_datetime">
  164.       <xf:label>ENCOUNTER DATETIME</xf:label>
  165.     </xf:input>
  166.     <xf:select1 bind="encounter.location_id">
  167.       <xf:label>LOCATION ID</xf:label>
  168.       <xf:item id="4">
  169.         <xf:label>Chulaimbo [4]</xf:label>
  170.         <xf:value>4</xf:value>
  171.       </xf:item>
  172.       <xf:item id="3">
  173.         <xf:label>Mosoriot Hospital [3]</xf:label>
  174.         <xf:value>3</xf:value>
  175.       </xf:item>
  176.       <xf:item id="1">
  177.         <xf:label>Unknown Location [1]</xf:label>
  178.         <xf:value>1</xf:value>
  179.       </xf:item>
  180.       <xf:item id="11">
  181.         <xf:label>Unknown Location 10 [11]</xf:label>
  182.         <xf:value>11</xf:value>
  183.       </xf:item>
  184.       <xf:item id="12">
  185.         <xf:label>Unknown Location 11 [12]</xf:label>
  186.         <xf:value>12</xf:value>
  187.       </xf:item>
  188.       <xf:item id="13">
  189.         <xf:label>Unknown Location 12 [13]</xf:label>
  190.         <xf:value>13</xf:value>
  191.       </xf:item>
  192.       <xf:item id="14">
  193.         <xf:label>Unknown Location 13 [14]</xf:label>
  194.         <xf:value>14</xf:value>
  195.       </xf:item>
  196.       <xf:item id="15">
  197.         <xf:label>Unknown Location 14 [15]</xf:label>
  198.         <xf:value>15</xf:value>
  199.       </xf:item>
  200.       <xf:item id="16">
  201.         <xf:label>Unknown Location 15 [16]</xf:label>
  202.         <xf:value>16</xf:value>
  203.       </xf:item>
  204.       <xf:item id="17">
  205.         <xf:label>Unknown Location 16 [17]</xf:label>
  206.         <xf:value>17</xf:value>
  207.       </xf:item>
  208.       <xf:item id="18">
  209.         <xf:label>Unknown Location 17 [18]</xf:label>
  210.         <xf:value>18</xf:value>
  211.       </xf:item>
  212.       <xf:item id="19">
  213.         <xf:label>Unknown Location 18 [19]</xf:label>
  214.         <xf:value>19</xf:value>
  215.       </xf:item>
  216.       <xf:item id="5">
  217.         <xf:label>Unknown Location 4 [5]</xf:label>
  218.         <xf:value>5</xf:value>
  219.       </xf:item>
  220.       <xf:item id="6">
  221.         <xf:label>Unknown Location 5 [6]</xf:label>
  222.         <xf:value>6</xf:value>
  223.       </xf:item>
  224.       <xf:item id="7">
  225.         <xf:label>Unknown Location 6 [7]</xf:label>
  226.         <xf:value>7</xf:value>
  227.       </xf:item>
  228.       <xf:item id="8">
  229.         <xf:label>Unknown Location 7 [8]</xf:label>
  230.         <xf:value>8</xf:value>
  231.       </xf:item>
  232.       <xf:item id="9">
  233.         <xf:label>Unknown Location 8 [9]</xf:label>
  234.         <xf:value>9</xf:value>
  235.       </xf:item>
  236.       <xf:item id="10">
  237.         <xf:label>Unknown Location 9  [10]</xf:label>
  238.         <xf:value>10</xf:value>
  239.       </xf:item>
  240.       <xf:item id="2">
  241.         <xf:label>Wishard Hospital [2]</xf:label>
  242.         <xf:value>2</xf:value>
  243.       </xf:item>
  244.     </xf:select1>
  245.     <xf:select1 bind="encounter.provider_id">
  246.       <xf:label>PROVIDER ID</xf:label>
  247.       <xf:item id="1">
  248.         <xf:label>Super User [admin]</xf:label>
  249.         <xf:value>1</xf:value>
  250.       </xf:item>
  251.     </xf:select1>
  252.     <xf:select1 bind="amputation">
  253.       <xf:label>AMPUTATION</xf:label>
  254.       <xf:hint>Has the patient ever had an AMPUTATION</xf:hint>
  255.       <xf:item concept_id="161573" id="161571^YES - DM RELATED^99DCT">
  256.         <xf:label>YES - DM RELATED</xf:label>
  257.         <xf:value>161571^YES - DM RELATED^99DCT</xf:value>
  258.       </xf:item>
  259.       <xf:item concept_id="161573" id="161572^YES - DM NOT RELATED^99DCT">
  260.         <xf:label>YES - DM NOT RELATED</xf:label>
  261.         <xf:value>161572^YES - DM NOT RELATED^99DCT</xf:value>
  262.       </xf:item>
  263.       <xf:item concept_id="161573" id="1066^NO^99DCT">
  264.         <xf:label>NO</xf:label>
  265.         <xf:value>1066^NO^99DCT</xf:value>
  266.       </xf:item>
  267.     </xf:select1><xf:input bind="side_effects">
  268.       <xf:label>SIDE EFFECTS</xf:label>
  269.       <xf:hint>Does the patient suffer from any side effects after using the drugs?</xf:hint>
  270.     </xf:input><xf:select1 bind="adherence">
  271.       <xf:label>ADHERENCE TO DRUGS</xf:label>
  272.       <xf:hint>Adherence to medication</xf:hint>
  273.       <xf:item concept_id="161581" id="159405^Good^99DCT">
  274.         <xf:label>Good</xf:label>
  275.         <xf:value>159405^Good^99DCT</xf:value>
  276.       </xf:item>
  277.       <xf:item concept_id="161581" id="159406^Fair^99DCT">
  278.         <xf:label>Fair</xf:label>
  279.         <xf:value>159406^Fair^99DCT</xf:value>
  280.       </xf:item>
  281.       <xf:item concept_id="161581" id="159407^Poor^99DCT">
  282.         <xf:label>Poor</xf:label>
  283.         <xf:value>159407^Poor^99DCT</xf:value>
  284.       </xf:item>
  285.       <xf:item concept_id="161581" id="1107^NONE^99DCT">
  286.         <xf:label>NONE</xf:label>
  287.         <xf:value>1107^NONE^99DCT</xf:value>
  288.       </xf:item>
  289.     </xf:select1><xf:group id="problem_list/problem_added">
  290.       <xf:label>PROBLEM ADDED</xf:label>
  291.       <xf:hint>Diagnosis or problem noted on a patient encounter. This corresponds to the list of "new" problems which are being added to the patient's list of problems. It refers to a health problem or diagnosis. Terms are added to this list typically by pressing a button which says New Problem or Add Problem.</xf:hint>
  292.       <xf:repeat bind="problem_added">
  293.         <xf:input bind="problem_list_problem_added_value">
  294.           <xf:label>problem_added value</xf:label>
  295.           <xf:hint>Diagnosis or problem noted on a patient encounter. This corresponds to the list of "new" problems which are being added to the patient's list of problems. It refers to a health problem or diagnosis. Terms are added to this list typically by pressing a button which says New Problem or Add Problem.</xf:hint>
  296.         </xf:input>
  297.       </xf:repeat>
  298.     </xf:group><xf:group id="problem_list/problem_resolved">
  299.       <xf:label>PROBLEM RESOLVED</xf:label>
  300.       <xf:hint>Diagnosis or problem noted on a patient encounter as being resolved.</xf:hint>
  301.       <xf:repeat bind="problem_resolved">
  302.         <xf:input bind="problem_list_problem_resolved_value">
  303.           <xf:label>problem_resolved value</xf:label>
  304.           <xf:hint>Diagnosis or problem noted on a patient encounter as being resolved.</xf:hint>
  305.         </xf:input>
  306.       </xf:repeat>
  307.     </xf:group><xf:select1 bind="family_history_of_diabetes_mellitus">
  308.       <xf:label>Family History of Diabetes Mellitus</xf:label>
  309.       <xf:item concept_id="140228" id="1066^NO^99DCT">
  310.         <xf:label>NO</xf:label>
  311.         <xf:value>1066^NO^99DCT</xf:value>
  312.       </xf:item>
  313.       <xf:item concept_id="140228" id="1065^YES^99DCT">
  314.         <xf:label>YES</xf:label>
  315.         <xf:value>1065^YES^99DCT</xf:value>
  316.       </xf:item>
  317.       <xf:item concept_id="140228" id="1067^UNKNOWN^99DCT">
  318.         <xf:label>UNKNOWN</xf:label>
  319.         <xf:value>1067^UNKNOWN^99DCT</xf:value>
  320.       </xf:item>
  321.     </xf:select1>
  322.     <xf:select1 bind="diabetes_mellitus">
  323.       <xf:label>Diabetes Mellitus</xf:label>
  324.       <xf:hint>A heterogeneous group of disorders that share glucose intolerance in common.</xf:hint>
  325.       <xf:item concept_id="119481" id="1066^NO^99DCT">
  326.         <xf:label>NO</xf:label>
  327.         <xf:value>1066^NO^99DCT</xf:value>
  328.       </xf:item>
  329.       <xf:item concept_id="119481" id="1065^YES^99DCT">
  330.         <xf:label>YES</xf:label>
  331.         <xf:value>1065^YES^99DCT</xf:value>
  332.       </xf:item>
  333.       <xf:item concept_id="119481" id="1067^UNKNOWN^99DCT">
  334.         <xf:label>UNKNOWN</xf:label>
  335.         <xf:value>1067^UNKNOWN^99DCT</xf:value>
  336.       </xf:item>
  337.     </xf:select1>
  338.    
  339.     <xf:select1 bind="smoker">
  340.       <xf:label>Smoker</xf:label>
  341.       <xf:item concept_id="152722" id="1065^YES^99DCT">
  342.         <xf:label>YES</xf:label>
  343.         <xf:value>1065^YES^99DCT</xf:value>
  344.       </xf:item>
  345.       <xf:item concept_id="152722" id="1066^NO^99DCT">
  346.         <xf:label>NO</xf:label>
  347.         <xf:value>1066^NO^99DCT</xf:value>
  348.       </xf:item>
  349.       <xf:item concept_id="152722" id="1067^UNKNOWN^99DCT">
  350.         <xf:label>UNKNOWN</xf:label>
  351.         <xf:value>1067^UNKNOWN^99DCT</xf:value>
  352.       </xf:item>
  353.     </xf:select1>
  354.     <xf:input bind="number_of_minutes_of_exercise_per_day">
  355.       <xf:label>Number of minutes of exercise per day</xf:label>
  356.     </xf:input><xf:input bind="free_text_comment">
  357.       <xf:label>Free text comment</xf:label>
  358.     </xf:input><xf:select bind="hypoglycemics">
  359.       <xf:label>HYPOGLYCEMICS</xf:label>
  360.       <xf:item concept_id="161608" id="insulin_70_slash_30">
  361.         <xf:label>INSULIN 70/30</xf:label>
  362.         <xf:value>insulin_70_slash_30</xf:value>
  363.       </xf:item>
  364.       <xf:item concept_id="161608" id="metformin">
  365.         <xf:label>METFORMIN</xf:label>
  366.         <xf:value>metformin</xf:value>
  367.       </xf:item>
  368.       <xf:item concept_id="161608" id="insulin_isophane_beef-pork">
  369.         <xf:label>INSULIN, ISOPHANE, BEEF-PORK</xf:label>
  370.         <xf:value>insulin_isophane_beef-pork</xf:value>
  371.       </xf:item>
  372.       <xf:item concept_id="161608" id="insulin_lente">
  373.         <xf:label>INSULIN, LENTE</xf:label>
  374.         <xf:value>insulin_lente</xf:value>
  375.       </xf:item>
  376.       <xf:item concept_id="161608" id="glyburide">
  377.         <xf:label>GLYBURIDE</xf:label>
  378.         <xf:value>glyburide</xf:value>
  379.       </xf:item>
  380.     </xf:select><xf:select bind="antihypersensitives">
  381.       <xf:label>ANTIHYPERSENSITIVES</xf:label>
  382.       <xf:item concept_id="161609" id="enalapril">
  383.         <xf:label>ENALAPRIL</xf:label>
  384.         <xf:value>enalapril</xf:value>
  385.       </xf:item>
  386.       <xf:item concept_id="161609" id="losartan">
  387.         <xf:label>LOSARTAN</xf:label>
  388.         <xf:value>losartan</xf:value>
  389.       </xf:item>
  390.       <xf:item concept_id="161609" id="atenolol">
  391.         <xf:label>ATENOLOL</xf:label>
  392.         <xf:value>atenolol</xf:value>
  393.       </xf:item>
  394.       <xf:item concept_id="161609" id="furosemide">
  395.         <xf:label>FUROSEMIDE</xf:label>
  396.         <xf:value>furosemide</xf:value>
  397.       </xf:item>
  398.       <xf:item concept_id="161609" id="nifedipine">
  399.         <xf:label>NIFEDIPINE</xf:label>
  400.         <xf:value>nifedipine</xf:value>
  401.       </xf:item>
  402.     </xf:select><xf:select1 bind="glucose_monitoring_at_home">
  403.       <xf:label>GLUCOSE MONITORING AT HOME</xf:label>
  404.       <xf:item concept_id="161580" id="1065^YES^99DCT">
  405.         <xf:label>YES</xf:label>
  406.         <xf:value>1065^YES^99DCT</xf:value>
  407.       </xf:item>
  408.       <xf:item concept_id="161580" id="1066^NO^99DCT">
  409.         <xf:label>NO</xf:label>
  410.         <xf:value>1066^NO^99DCT</xf:value>
  411.       </xf:item>
  412.     </xf:select1>
  413.    
  414.    
  415.    
  416.    
  417.    
  418.    
  419.    
  420.    
  421.     <xf:group id="diabetes_mellitus">
  422.       <xf:label>Diabetes Mellitus</xf:label>
  423.       <xf:hint>A heterogeneous group of disorders that share glucose intolerance in common.</xf:hint>
  424.       <xf:input bind="diagnosis_date">
  425.         <xf:label>Diagnosis date</xf:label>
  426.         <xf:hint>The date the diagnosis was first made for the patient.</xf:hint>
  427.       </xf:input>
  428.     </xf:group>
  429.     <xf:group id="myocardial_infarction">
  430.       <xf:label>Myocardial Infarction</xf:label>
  431.       <xf:hint>Gross necrosis of the myocardium, as a result of interruption of the blood supply to the area. (Dorland, 27th ed)</xf:hint>
  432.       <xf:input bind="myocardial_infarction_diagnosis_date">
  433.         <xf:label>Diagnosis date</xf:label>
  434.         <xf:hint>The date the diagnosis was first made for the patient.</xf:hint>
  435.       </xf:input>
  436.     </xf:group>
  437.     <xf:group id="cerebrovascular_accident">
  438.       <xf:label>Cerebrovascular Accident</xf:label>
  439.       <xf:hint>A sudden, nonconvulsive loss of neurologic function due to an ischemic or hemorrhagic intracranial vascular event. In general, cerebrovascular accidents are classified by anatomic location in the brain, vascular distribution, etiology, age of the affected individual, and hemorrhagic vs. nonhemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)</xf:hint>
  440.       <xf:input bind="cerebrovascular_accident_diagnosis_date">
  441.         <xf:label>Diagnosis date</xf:label>
  442.         <xf:hint>The date the diagnosis was first made for the patient.</xf:hint>
  443.       </xf:input>
  444.     </xf:group>
  445.     <xf:group id="htn_hypertension">
  446.       <xf:label>High blood pressure</xf:label>
  447.       <xf:hint>Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure.</xf:hint>
  448.       <xf:input bind="htn_hypertension_diagnosis_date">
  449.         <xf:label>Diagnosis date</xf:label>
  450.         <xf:hint>The date the diagnosis was first made for the patient.</xf:hint>
  451.       </xf:input>
  452.     </xf:group>
  453.   </xf:group>
  454. </xf:xforms>
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