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jerome24

counselling xform1

jerome24
May 24th, 2024
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  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 id="openmrs_model">
  4. <xf:instance id="openmrs_model_instance">
  5. <form xmlns:openmrs="formentry.infopath_server_url cannot be empty/moduleServlet/formentry/forms/schema/67-1" xmlns:xd="http://schemas.microsoft.com/office/infopath/2003" id="67" name="Counselling form test" uuid="6e2f2273-ae88-48a0-a5bc-c0eebcf9cf61" version="1.3">
  6. <header>
  7. <enterer/>
  8. <date_entered/>
  9. <session/>
  10. <uid/>
  11. </header>
  12. <patient>
  13. <patient.birthdate openmrs_attribute="birthdate" openmrs_table="patient"/>
  14. <patient.family_name openmrs_attribute="family_name" openmrs_table="patient_name"/>
  15. <patient.given_name openmrs_attribute="given_name" openmrs_table="patient_name"/>
  16. <patient.medical_record_number openmrs_attribute="identifier" openmrs_table="patient_identifier"/>
  17. <patient.middle_name openmrs_attribute="middle_name" openmrs_table="patient_name"/>
  18. <patient.patient_id openmrs_attribute="patient_id" openmrs_table="patient"/>
  19. <patient.sex openmrs_attribute="gender" openmrs_table="patient"/>
  20. <patient_relative>
  21. <patient_relative.person/>
  22. <patient_relative.relationship/>
  23. </patient_relative>
  24. </patient>
  25. <encounter>
  26. <encounter.encounter_datetime openmrs_attribute="encounter_datetime" openmrs_table="encounter" xsi:nil="true">'today()'</encounter.encounter_datetime>
  27. <encounter.location_id openmrs_attribute="location_id" openmrs_table="encounter" xsi:nil="true">1</encounter.location_id>
  28. <encounter.provider_id openmrs_attribute="provider_id" openmrs_table="encounter" provider_id_type="PROVIDER.ID" xsi:nil="true"/>
  29. </encounter>
  30. <obs openmrs_concept="3^ANEMIA^99DCT" openmrs_datatype="ZZ">
  31. <if_partner_is_tested_negative_prep_service multiple="0" openmrs_concept="163188^If Partner is tested Negative, PrEP service^99DCT" openmrs_datatype="CWE">
  32. <date xsi:nil="true"/>
  33. <time xsi:nil="true"/>
  34. <value xsi:nil="true"/>
  35. </if_partner_is_tested_negative_prep_service>
  36. <if_yes_enter_the_nacp_number openmrs_concept="163185^If Yes, enter the NACP number^99DCT" openmrs_datatype="ST">
  37. <date xsi:nil="true"/>
  38. <time xsi:nil="true"/>
  39. <value xsi:nil="true"/>
  40. </if_yes_enter_the_nacp_number>
  41. <if_positive_does_he_or_she_enrolled_in_kiularco multiple="0" openmrs_concept="163184^If Positive, does he or she enrolled in KIULARCO?^99DCT" openmrs_datatype="CWE">
  42. <date xsi:nil="true"/>
  43. <time xsi:nil="true"/>
  44. <value xsi:nil="true"/>
  45. </if_positive_does_he_or_she_enrolled_in_kiularco>
  46. <partner_result multiple="0" openmrs_concept="163183^Partner result^99DCT" openmrs_datatype="CWE">
  47. <date xsi:nil="true"/>
  48. <time xsi:nil="true"/>
  49. <value xsi:nil="true"/>
  50. </partner_result>
  51. <partner_tested multiple="0" openmrs_concept="163182^Partner tested^99DCT" openmrs_datatype="CWE">
  52. <date xsi:nil="true"/>
  53. <time xsi:nil="true"/>
  54. <value xsi:nil="true"/>
  55. </partner_tested>
  56. <visitect_res multiple="0" openmrs_concept="163119^VISITECT_RES^99DCT" openmrs_datatype="CWE">
  57. <date xsi:nil="true"/>
  58. <time xsi:nil="true"/>
  59. <value xsi:nil="true"/>
  60. </visitect_res>
  61. <visitect multiple="0" openmrs_concept="163115^VISITECT^99DCT" openmrs_datatype="CWE">
  62. <date xsi:nil="true"/>
  63. <time xsi:nil="true"/>
  64. <value xsi:nil="true"/>
  65. </visitect>
  66. <yes_controlling openmrs_concept="163113^YES_CONTROLLING^99DCT" openmrs_datatype="ST">
  67. <date xsi:nil="true"/>
  68. <time xsi:nil="true"/>
  69. <value xsi:nil="true"/>
  70. </yes_controlling>
  71. <controlling multiple="0" openmrs_concept="163112^CONTROLLING^99DCT" openmrs_datatype="CWE">
  72. <date xsi:nil="true"/>
  73. <time xsi:nil="true"/>
  74. <value xsi:nil="true"/>
  75. </controlling>
  76. <yes_verbal openmrs_concept="163111^YES_VERBAL^99DCT" openmrs_datatype="ST">
  77. <date xsi:nil="true"/>
  78. <time xsi:nil="true"/>
  79. <value xsi:nil="true"/>
  80. </yes_verbal>
  81. <verbal multiple="0" openmrs_concept="163110^VERBAL^99DCT" openmrs_datatype="CWE">
  82. <date xsi:nil="true"/>
  83. <time xsi:nil="true"/>
  84. <value xsi:nil="true"/>
  85. </verbal>
  86. <yes_force_abort openmrs_concept="163109^YES_FORCE_ABORT^99DCT" openmrs_datatype="ST">
  87. <date xsi:nil="true"/>
  88. <time xsi:nil="true"/>
  89. <value xsi:nil="true"/>
  90. </yes_force_abort>
  91. <force_abort multiple="0" openmrs_concept="163108^FORCE_ABORT^99DCT" openmrs_datatype="CWE">
  92. <date xsi:nil="true"/>
  93. <time xsi:nil="true"/>
  94. <value xsi:nil="true"/>
  95. </force_abort>
  96. <yes_force_marriage openmrs_concept="163107^YES_FORCE_MARRIAGE^99DCT" openmrs_datatype="ST">
  97. <date xsi:nil="true"/>
  98. <time xsi:nil="true"/>
  99. <value xsi:nil="true"/>
  100. </yes_force_marriage>
  101. <forced_marriage multiple="0" openmrs_concept="163106^FORCED_MARRIAGE^99DCT" openmrs_datatype="CWE">
  102. <date xsi:nil="true"/>
  103. <time xsi:nil="true"/>
  104. <value xsi:nil="true"/>
  105. </forced_marriage>
  106. <yes_unwill_preg openmrs_concept="163105^YES_UNWILL_PREG^99DCT" openmrs_datatype="ST">
  107. <date xsi:nil="true"/>
  108. <time xsi:nil="true"/>
  109. <value xsi:nil="true"/>
  110. </yes_unwill_preg>
  111. <unwill_preg multiple="0" openmrs_concept="163104^UNWILL_PREG^99DCT" openmrs_datatype="CWE">
  112. <date xsi:nil="true"/>
  113. <time xsi:nil="true"/>
  114. <value xsi:nil="true"/>
  115. </unwill_preg>
  116. <yes_danger_sex openmrs_concept="163103^YES_DANGER_SEX^99DCT" openmrs_datatype="ST">
  117. <date xsi:nil="true"/>
  118. <time xsi:nil="true"/>
  119. <value xsi:nil="true"/>
  120. </yes_danger_sex>
  121. <danger_sex multiple="0" openmrs_concept="163102^DANGER_SEX^99DCT" openmrs_datatype="CWE">
  122. <date xsi:nil="true"/>
  123. <time xsi:nil="true"/>
  124. <value xsi:nil="true"/>
  125. </danger_sex>
  126. <yes_unwill_sex openmrs_concept="163101^YES_UNWILL_SEX^99DCT" openmrs_datatype="ST">
  127. <date xsi:nil="true"/>
  128. <time xsi:nil="true"/>
  129. <value xsi:nil="true"/>
  130. </yes_unwill_sex>
  131. <unwill_sex multiple="0" openmrs_concept="163100^UNWILL_SEX^99DCT" openmrs_datatype="CWE">
  132. <date xsi:nil="true"/>
  133. <time xsi:nil="true"/>
  134. <value xsi:nil="true"/>
  135. </unwill_sex>
  136. <yes_physical openmrs_concept="163099^YES_PHYSICAL^99DCT" openmrs_datatype="ST">
  137. <date xsi:nil="true"/>
  138. <time xsi:nil="true"/>
  139. <value xsi:nil="true"/>
  140. </yes_physical>
  141. <physical multiple="0" openmrs_concept="163098^PHYSICAL^99DCT" openmrs_datatype="CWE">
  142. <date xsi:nil="true"/>
  143. <time xsi:nil="true"/>
  144. <value xsi:nil="true"/>
  145. </physical>
  146. <yes_emotional openmrs_concept="163097^YES_EMOTIONAL^99DCT" openmrs_datatype="ST">
  147. <date xsi:nil="true"/>
  148. <time xsi:nil="true"/>
  149. <value xsi:nil="true"/>
  150. </yes_emotional>
  151. <emotional multiple="0" openmrs_concept="163096^EMOTIONAL^99DCT" openmrs_datatype="CWE">
  152. <date xsi:nil="true"/>
  153. <time xsi:nil="true"/>
  154. <value xsi:nil="true"/>
  155. </emotional>
  156. <gbv_any multiple="0" openmrs_concept="163095^GBV_ANY^99DCT" openmrs_datatype="CWE">
  157. <date xsi:nil="true"/>
  158. <time xsi:nil="true"/>
  159. <value xsi:nil="true"/>
  160. </gbv_any>
  161. <gbv_screen multiple="0" openmrs_concept="163090^GBV_SCREEN^99DCT" openmrs_datatype="CWE">
  162. <date xsi:nil="true"/>
  163. <time xsi:nil="true"/>
  164. <value xsi:nil="true"/>
  165. </gbv_screen>
  166. <group_therapy_-_notes openmrs_concept="162815^Group Therapy - Notes^99DCT" openmrs_datatype="ST">
  167. <date xsi:nil="true"/>
  168. <time xsi:nil="true"/>
  169. <value xsi:nil="true"/>
  170. </group_therapy_-_notes>
  171. <number_of_sessions_-_group_therapy openmrs_concept="162814^Number of Sessions - Group Therapy^99DCT" openmrs_datatype="NM">
  172. <date xsi:nil="true"/>
  173. <time xsi:nil="true"/>
  174. <value xsi:nil="true"/>
  175. </number_of_sessions_-_group_therapy>
  176. <group_therapy_status multiple="0" openmrs_concept="162813^Group Therapy Status^99DCT" openmrs_datatype="CWE">
  177. <date xsi:nil="true"/>
  178. <time xsi:nil="true"/>
  179. <value xsi:nil="true"/>
  180. </group_therapy_status>
  181. <depression_questionnaire_-_notes openmrs_concept="162812^Depression Questionnaire - Notes^99DCT" openmrs_datatype="ST">
  182. <date xsi:nil="true"/>
  183. <time xsi:nil="true"/>
  184. <value xsi:nil="true"/>
  185. </depression_questionnaire_-_notes>
  186. <depression_score openmrs_concept="162811^Depression Score^99DCT" openmrs_datatype="NM">
  187. <date xsi:nil="true"/>
  188. <time xsi:nil="true"/>
  189. <value xsi:nil="true"/>
  190. </depression_score>
  191. <depression_questionnaires_status multiple="0" openmrs_concept="162810^Depression Questionnaires Status^99DCT" openmrs_datatype="CWE">
  192. <date xsi:nil="true"/>
  193. <time xsi:nil="true"/>
  194. <value xsi:nil="true"/>
  195. </depression_questionnaires_status>
  196. <stigma_video_-_notes openmrs_concept="162809^Stigma Video - Notes^99DCT" openmrs_datatype="ST">
  197. <date xsi:nil="true"/>
  198. <time xsi:nil="true"/>
  199. <value xsi:nil="true"/>
  200. </stigma_video_-_notes>
  201. <stigma_video_status multiple="0" openmrs_concept="162808^Stigma Video Status^99DCT" openmrs_datatype="CWE">
  202. <date xsi:nil="true"/>
  203. <time xsi:nil="true"/>
  204. <value xsi:nil="true"/>
  205. </stigma_video_status>
  206. <stigma_questionnaire_-_notes openmrs_concept="162807^Stigma Questionnaire - Notes^99DCT" openmrs_datatype="ST">
  207. <date xsi:nil="true"/>
  208. <time xsi:nil="true"/>
  209. <value xsi:nil="true"/>
  210. </stigma_questionnaire_-_notes>
  211. <total_score_-_stigma_questionnaire openmrs_concept="162806^Stigma Score^99DCT" openmrs_datatype="NM">
  212. <date xsi:nil="true"/>
  213. <time xsi:nil="true"/>
  214. <value xsi:nil="true"/>
  215. </total_score_-_stigma_questionnaire>
  216. <stigma_questionnaires_status multiple="0" openmrs_concept="162805^Stigma Questionnaires Status^99DCT" openmrs_datatype="CWE">
  217. <date xsi:nil="true"/>
  218. <time xsi:nil="true"/>
  219. <value xsi:nil="true"/>
  220. </stigma_questionnaires_status>
  221. <questionnaires_status multiple="0" openmrs_concept="162804^Questionnaires Status^99DCT" openmrs_datatype="CWE">
  222. <date xsi:nil="true"/>
  223. <time xsi:nil="true"/>
  224. <value xsi:nil="true"/>
  225. </questionnaires_status>
  226. <counselling_notes openmrs_concept="162803^Counselling Notes^99DCT" openmrs_datatype="ST">
  227. <date xsi:nil="true"/>
  228. <time xsi:nil="true"/>
  229. <value xsi:nil="true"/>
  230. </counselling_notes>
  231. <others_-_counselling_section openmrs_concept="162802^Others - Counselling Section^99DCT" openmrs_datatype="ST">
  232. <date xsi:nil="true"/>
  233. <time xsi:nil="true"/>
  234. <value xsi:nil="true"/>
  235. </others_-_counselling_section>
  236. <other_counselling_purpose multiple="0" openmrs_concept="162801^Other Counselling Purpose^99DCT" openmrs_datatype="CWE">
  237. <date xsi:nil="true"/>
  238. <time xsi:nil="true"/>
  239. <value xsi:nil="true"/>
  240. </other_counselling_purpose>
  241. <prep_counselling multiple="0" openmrs_concept="162800^PrEP Counselling^99DCT" openmrs_datatype="CWE">
  242. <date xsi:nil="true"/>
  243. <time xsi:nil="true"/>
  244. <value xsi:nil="true"/>
  245. </prep_counselling>
  246. <disclosure_counselling multiple="0" openmrs_concept="162799^Disclosure Counselling^99DCT" openmrs_datatype="CWE">
  247. <date xsi:nil="true"/>
  248. <time xsi:nil="true"/>
  249. <value xsi:nil="true"/>
  250. </disclosure_counselling>
  251. <pmtct_counselling multiple="0" openmrs_concept="162796^PMTCT Counselling^99DCT" openmrs_datatype="CWE">
  252. <date xsi:nil="true"/>
  253. <time xsi:nil="true"/>
  254. <value xsi:nil="true"/>
  255. </pmtct_counselling>
  256. <lay_counselling multiple="0" openmrs_concept="162795^Lay Counselling^99DCT" openmrs_datatype="CWE">
  257. <date xsi:nil="true"/>
  258. <time xsi:nil="true"/>
  259. <value xsi:nil="true"/>
  260. </lay_counselling>
  261. <adherence_counselling multiple="0" openmrs_concept="162794^Adherence Counselling^99DCT" openmrs_datatype="CWE">
  262. <date xsi:nil="true"/>
  263. <time xsi:nil="true"/>
  264. <value xsi:nil="true"/>
  265. </adherence_counselling>
  266. <enhanced_adherence_counselling multiple="0" openmrs_concept="162793^Enhanced Adherence Counselling^99DCT" openmrs_datatype="CWE">
  267. <date xsi:nil="true"/>
  268. <time xsi:nil="true"/>
  269. <value xsi:nil="true"/>
  270. </enhanced_adherence_counselling>
  271. <pre-art_counselling multiple="0" openmrs_concept="162792^Pre-ART Counselling^99DCT" openmrs_datatype="CWE">
  272. <date xsi:nil="true"/>
  273. <time xsi:nil="true"/>
  274. <value xsi:nil="true"/>
  275. </pre-art_counselling>
  276. <counselling_status multiple="0" openmrs_concept="162788^Counselling Status^99DCT" openmrs_datatype="CWE">
  277. <date xsi:nil="true"/>
  278. <time xsi:nil="true"/>
  279. <value xsi:nil="true"/>
  280. </counselling_status>
  281. </obs>
  282. </form>
  283. </xf:instance>
  284. <xf:bind id="patient.birthdate" jr:preload="patient" jr:preloadParams="birthDate" locked="true()" nodeset="/form/patient/patient.birthdate" type="xsd:date"/>
  285. <xf:bind id="patient.family_name" jr:preload="patient" jr:preloadParams="familyName" locked="true()" nodeset="/form/patient/patient.family_name" type="xsd:string"/>
  286. <xf:bind id="patient.given_name" jr:preload="patient" jr:preloadParams="givenName" locked="true()" nodeset="/form/patient/patient.given_name" type="xsd:string"/>
  287. <xf:bind id="patient.medical_record_number" jr:preload="patient" jr:preloadParams="patientIdentifier" locked="true()" nodeset="/form/patient/patient.medical_record_number" type="xsd:string"/>
  288. <xf:bind id="patient.middle_name" jr:preload="patient" jr:preloadParams="middleName" locked="true()" nodeset="/form/patient/patient.middle_name" type="xsd:string"/>
  289. <xf:bind id="patient.patient_id" jr:preload="patient" jr:preloadParams="patientId" nodeset="/form/patient/patient.patient_id" required="true()" type="xsd:int" visible="false()"/>
  290. <xf:bind id="patient.sex" jr:preload="patient" jr:preloadParams="sex" locked="true()" nodeset="/form/patient/patient.sex" type="xsd:string"/>
  291. <xf:bind constraint=". &lt;= today()" id="encounter.encounter_datetime" message="Encounter date cannot be after today" nodeset="/form/encounter/encounter.encounter_datetime" required="true()" type="xsd:dateTime"/>
  292. <xf:bind id="encounter.location_id" nodeset="/form/encounter/encounter.location_id" readonly="true()" type="xsd:string"/>
  293. <xf:bind id="encounter.provider_id" nodeset="/form/encounter/encounter.provider_id" required="true()" type="xsd:string"/>
  294. <xf:bind action="enable" id="group_therapy_-_notes" nodeset="/form/obs/group_therapy_-_notes/value" relevant="/form/obs/group_therapy_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="number_of_sessions_-_group_therapy" nodeset="/form/obs/number_of_sessions_-_group_therapy/value" relevant="/form/obs/group_therapy_status/value = '162787^Done^99DCT'" required="false()" type="xsd:decimal"/><xf:bind id="group_therapy_status" nodeset="/form/obs/group_therapy_status/value" required="true()" type="xsd:string"/><xf:bind action="enable" id="depression_questionnaire_-_notes" nodeset="/form/obs/depression_questionnaire_-_notes/value" relevant="/form/obs/depression_questionnaires_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="depression_score" nodeset="/form/obs/depression_score/value" relevant="/form/obs/depression_questionnaires_status/value = '162787^Done^99DCT'" required="false()" type="xsd:decimal"/><xf:bind action="enable" id="depression_questionnaires_status" nodeset="/form/obs/depression_questionnaires_status/value" relevant="/form/obs/questionnaires_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="stigma_video_-_notes" nodeset="/form/obs/stigma_video_-_notes/value" relevant="/form/obs/stigma_video_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind id="stigma_video_status" nodeset="/form/obs/stigma_video_status/value" required="true()" type="xsd:string"/><xf:bind action="enable" id="stigma_questionnaire_-_notes" nodeset="/form/obs/stigma_questionnaire_-_notes/value" relevant="/form/obs/stigma_questionnaires_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="total_score_-_stigma_questionnaire" nodeset="/form/obs/total_score_-_stigma_questionnaire/value" relevant="/form/obs/stigma_questionnaires_status/value = '162787^Done^99DCT'" required="false()" type="xsd:decimal"/><xf:bind action="enable" id="stigma_questionnaires_status" nodeset="/form/obs/stigma_questionnaires_status/value" relevant="/form/obs/questionnaires_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind id="questionnaires_status" nodeset="/form/obs/questionnaires_status/value" required="true()" type="xsd:string"/><xf:bind id="counselling_notes" nodeset="/form/obs/counselling_notes/value" type="xsd:string"/><xf:bind action="enable" id="others_-_counselling_section" nodeset="/form/obs/others_-_counselling_section/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="other_counselling_purpose" nodeset="/form/obs/other_counselling_purpose/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="prep_counselling" nodeset="/form/obs/prep_counselling/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="disclosure_counselling" nodeset="/form/obs/disclosure_counselling/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="pmtct_counselling" nodeset="/form/obs/pmtct_counselling/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="lay_counselling" nodeset="/form/obs/lay_counselling/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="adherence_counselling" nodeset="/form/obs/adherence_counselling/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="enhanced_adherence_counselling" nodeset="/form/obs/enhanced_adherence_counselling/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind action="enable" id="pre-art_counselling" nodeset="/form/obs/pre-art_counselling/value" relevant="/form/obs/counselling_status/value = '162787^Done^99DCT'" required="false()" type="xsd:string"/><xf:bind id="counselling_status" nodeset="/form/obs/counselling_status/value" required="true()" type="xsd:string"/><xf:bind id="patient_relative" nodeset="/form/patient/patient_relative"/><xf:bind action="enable" id="yes_controlling" nodeset="/form/obs/yes_controlling/value" relevant="/form/obs/controlling/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="controlling" nodeset="/form/obs/controlling/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_verbal" nodeset="/form/obs/yes_verbal/value" relevant="/form/obs/verbal/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="verbal" nodeset="/form/obs/verbal/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_force_abort" nodeset="/form/obs/yes_force_abort/value" relevant="/form/obs/force_abort/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="force_abort" nodeset="/form/obs/force_abort/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT' and /form/patient/patient.sex = 'F'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_force_marriage" nodeset="/form/obs/yes_force_marriage/value" relevant="/form/obs/forced_marriage/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="forced_marriage" nodeset="/form/obs/forced_marriage/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_unwill_preg" nodeset="/form/obs/yes_unwill_preg/value" relevant="/form/obs/unwill_preg/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="unwill_preg" nodeset="/form/obs/unwill_preg/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT' and /form/patient/patient.sex = 'F'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_danger_sex" nodeset="/form/obs/yes_danger_sex/value" relevant="/form/obs/danger_sex/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="danger_sex" nodeset="/form/obs/danger_sex/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_unwill_sex" nodeset="/form/obs/yes_unwill_sex/value" relevant="/form/obs/unwill_sex/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="unwill_sex" nodeset="/form/obs/unwill_sex/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_physical" nodeset="/form/obs/yes_physical/value" relevant="/form/obs/physical/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="physical" nodeset="/form/obs/physical/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="yes_emotional" nodeset="/form/obs/yes_emotional/value" relevant="/form/obs/emotional/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="emotional" nodeset="/form/obs/emotional/value" relevant="/form/obs/gbv_any/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind action="enable" id="gbv_any" nodeset="/form/obs/gbv_any/value" relevant="/form/obs/gbv_screen/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind id="gbv_screen" nodeset="/form/obs/gbv_screen/value" required="true()" type="xsd:string"/><xf:bind action="enable" id="visitect_res" nodeset="/form/obs/visitect_res/value" relevant="/form/obs/visitect/value = '1065^YES^99DCT'" required="true()" type="xsd:string"/><xf:bind id="visitect" nodeset="/form/obs/visitect/value" type="xsd:string"/><xf:bind action="enable" id="if_partner_is_tested_negative_prep_service" nodeset="/form/obs/if_partner_is_tested_negative_prep_service/value" relevant="/form/obs/partner_tested/value = '1065^YES^99DCT' and /form/obs/partner_result/value = '664^NEGATIVE^99DCT'" required="false()" type="xsd:string"/>
  295. <xf:bind action="enable" id="if_yes_enter_the_nacp_number" nodeset="/form/obs/if_yes_enter_the_nacp_number/value" relevant="/form/obs/if_positive_does_he_or_she_enrolled_in_kiularco/value = '1065^YES^99DCT'" required="false()" type="xsd:string"/>
  296. <xf:bind action="enable" id="if_positive_does_he_or_she_enrolled_in_kiularco" nodeset="/form/obs/if_positive_does_he_or_she_enrolled_in_kiularco/value" relevant="/form/obs/partner_tested/value = '1065^YES^99DCT' and /form/obs/partner_result/value = '703^POSITIVE^99DCT'" required="false()" type="xsd:string"/>
  297. <xf:bind action="enable" id="partner_result" nodeset="/form/obs/partner_result/value" relevant="/form/obs/partner_tested/value = '1065^YES^99DCT'" required="false()" type="xsd:string"/>
  298. <xf:bind id="partner_tested" nodeset="/form/obs/partner_tested/value" type="xsd:string"/>
  299.  
  300.  
  301.  
  302.  
  303.  
  304.  
  305.  
  306.  
  307.  
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  309.  
  310.  
  311.  
  312.  
  313.  
  314.  
  315.  
  316.  
  317.  
  318.  
  319.  
  320.  
  321.  
  322.  
  323.  
  324.  
  325.  
  326.  
  327.  
  328.  
  329.  
  330.  
  331.  
  332.  
  333.  
  334.  
  335.  
  336.  
  337.  
  338.  
  339.  
  340.  
  341.  
  342.  
  343.  
  344.  
  345. <xf:bind id="patient_relative.person" nodeset="/form/patient/patient_relative/patient_relative.person" type="xsd:string"/>
  346. <xf:bind id="patient_relative.relationship" nodeset="/form/patient/patient_relative/patient_relative.relationship" type="xsd:string"/>
  347. </xf:model>
  348. <xf:group id="1">
  349. <xf:label>Page1</xf:label>
  350. <xf:input bind="patient.birthdate">
  351. <xf:label>BIRTHDATE</xf:label>
  352. </xf:input>
  353. <xf:input bind="patient.family_name">
  354. <xf:label>FAMILY NAME</xf:label>
  355. </xf:input>
  356. <xf:input bind="patient.given_name">
  357. <xf:label>GIVEN NAME</xf:label>
  358. </xf:input>
  359. <xf:input bind="patient.medical_record_number">
  360. <xf:label>MEDICAL RECORD NUMBER</xf:label>
  361. </xf:input>
  362. <xf:input bind="patient.middle_name">
  363. <xf:label>MIDDLE NAME</xf:label>
  364. </xf:input>
  365. <xf:input bind="patient.patient_id">
  366. <xf:label>PATIENT ID</xf:label>
  367. </xf:input>
  368. <xf:input bind="patient.sex">
  369. <xf:label>SEX</xf:label>
  370. </xf:input>
  371. <xf:input bind="encounter.encounter_datetime">
  372. <xf:label>ENCOUNTER DATETIME</xf:label>
  373. </xf:input>
  374. <xf:select1 bind="encounter.location_id">
  375. <xf:label>LOCATION ID</xf:label>
  376. <xf:item id="1">
  377. <xf:label>Unknown Location [1]</xf:label>
  378. <xf:value>1</xf:value>
  379. </xf:item>
  380. </xf:select1>
  381. <xf:select1 bind="encounter.provider_id">
  382. <xf:label>PROVIDER ID</xf:label>
  383. <xf:item id="1">
  384. <xf:label>Claudio Zaugg [12]</xf:label>
  385. <xf:value>1</xf:value>
  386. </xf:item>
  387. <xf:item id="2">
  388. <xf:label>Lucas Gervas Shayo [13]</xf:label>
  389. <xf:value>2</xf:value>
  390. </xf:item>
  391. <xf:item id="4">
  392. <xf:label>Agata Correia Agata [3]</xf:label>
  393. <xf:value>4</xf:value>
  394. </xf:item>
  395. <xf:item id="5">
  396. <xf:label>Maja Weisser</xf:label>
  397. <xf:value>5</xf:value>
  398. </xf:item>
  399. <xf:item id="6">
  400. <xf:label>Herry Robert Mapesi</xf:label>
  401. <xf:value>6</xf:value>
  402. </xf:item>
  403. <xf:item id="7">
  404. <xf:label>George Rocky Sikalengo</xf:label>
  405. <xf:value>7</xf:value>
  406. </xf:item>
  407. <xf:item id="8">
  408. <xf:label>ANDREW KATENDE</xf:label>
  409. <xf:value>8</xf:value>
  410. </xf:item>
  411. <xf:item id="9">
  412. <xf:label>Robert Christopher Ndege</xf:label>
  413. <xf:value>9</xf:value>
  414. </xf:item>
  415. <xf:item id="10">
  416. <xf:label>Getrud Joseph Mollel</xf:label>
  417. <xf:value>10</xf:value>
  418. </xf:item>
  419. <xf:item id="11">
  420. <xf:label>Ezekiel Luoga</xf:label>
  421. <xf:value>11</xf:value>
  422. </xf:item>
  423. <xf:item id="12">
  424. <xf:label>Lilian Moshi</xf:label>
  425. <xf:value>12</xf:value>
  426. </xf:item>
  427. <xf:item id="13">
  428. <xf:label>Vanesa Anton Vazquez</xf:label>
  429. <xf:value>13</xf:value>
  430. </xf:item>
  431. <xf:item id="14">
  432. <xf:label>Rahel Bircher</xf:label>
  433. <xf:value>14</xf:value>
  434. </xf:item>
  435. <xf:item id="15">
  436. <xf:label>Gidion Fue</xf:label>
  437. <xf:value>15</xf:value>
  438. </xf:item>
  439. <xf:item id="16">
  440. <xf:label>Athuman Mtandanguo</xf:label>
  441. <xf:value>16</xf:value>
  442. </xf:item>
  443. <xf:item id="17">
  444. <xf:label>Specioza Hwaya</xf:label>
  445. <xf:value>17</xf:value>
  446. </xf:item>
  447. <xf:item id="18">
  448. <xf:label>Armon Arpagaus</xf:label>
  449. <xf:value>18</xf:value>
  450. </xf:item>
  451. <xf:item id="19">
  452. <xf:label>Sambuta Aloyce [125-5]</xf:label>
  453. <xf:value>19</xf:value>
  454. </xf:item>
  455. <xf:item id="20">
  456. <xf:label>Anna Eichenberger [129-7]</xf:label>
  457. <xf:value>20</xf:value>
  458. </xf:item>
  459. <xf:item id="21">
  460. <xf:label>Felister Godson Kiwelu</xf:label>
  461. <xf:value>21</xf:value>
  462. </xf:item>
  463. <xf:item id="22">
  464. <xf:label>Phamarcy CDCI [132-1]</xf:label>
  465. <xf:value>22</xf:value>
  466. </xf:item>
  467. <xf:item id="23">
  468. <xf:label>Pharmacy one Stop [133-9]</xf:label>
  469. <xf:value>23</xf:value>
  470. </xf:item>
  471. <xf:item id="24">
  472. <xf:label>Linn Jarte</xf:label>
  473. <xf:value>24</xf:value>
  474. </xf:item>
  475. <xf:item id="25">
  476. <xf:label>Omary Ngome Rajab [137-0]</xf:label>
  477. <xf:value>25</xf:value>
  478. </xf:item>
  479. <xf:item id="26">
  480. <xf:label>Laura Gimenez Letona [139-6]</xf:label>
  481. <xf:value>26</xf:value>
  482. </xf:item>
  483. <xf:item id="27">
  484. <xf:label>Herieth wilson ismael [140-4]</xf:label>
  485. <xf:value>27</xf:value>
  486. </xf:item>
  487. <xf:item id="28">
  488. <xf:label>Selerine John Myeya [60-4]</xf:label>
  489. <xf:value>28</xf:value>
  490. </xf:item>
  491. <xf:item id="29">
  492. <xf:label>PHILIP SCHMASSMANN [141-2]</xf:label>
  493. <xf:value>29</xf:value>
  494. </xf:item>
  495. <xf:item id="30">
  496. <xf:label>Elizabeth Eliet Senkoro [142-0]</xf:label>
  497. <xf:value>30</xf:value>
  498. </xf:item>
  499. <xf:item id="31">
  500. <xf:label>Vera Hodel [143-8]</xf:label>
  501. <xf:value>31</xf:value>
  502. </xf:item>
  503. <xf:item id="32">
  504. <xf:label>Joshua Joseph Kapungu [144-6]</xf:label>
  505. <xf:value>32</xf:value>
  506. </xf:item>
  507. <xf:item id="33">
  508. <xf:label>Andre Hofer [146-1]</xf:label>
  509. <xf:value>33</xf:value>
  510. </xf:item>
  511.  
  512. <xf:item id="35">
  513. <xf:label>James Okuma [148-7]</xf:label>
  514. <xf:value>35</xf:value>
  515. </xf:item>
  516. <xf:item id="36">
  517. <xf:label>Sandra Glauser [149-5]</xf:label>
  518. <xf:value>36</xf:value>
  519. </xf:item>
  520. <xf:item id="37">
  521. <xf:label>Raphael Magnolini [151-1]</xf:label>
  522. <xf:value>37</xf:value>
  523. </xf:item>
  524. <xf:item id="38">
  525. <xf:label>Olivia John Kitau [152-9]</xf:label>
  526. <xf:value>38</xf:value>
  527. </xf:item>
  528. <xf:item id="39">
  529. <xf:label>Alois Mbuta [153-7]</xf:label>
  530. <xf:value>39</xf:value>
  531. </xf:item>
  532. <xf:item id="40">
  533. <xf:label>Paul Camille Genton [154-5]</xf:label>
  534. <xf:value>40</xf:value>
  535. </xf:item>
  536. <xf:item id="41">
  537. <xf:label>Evarist Chiweka [19-0]</xf:label>
  538. <xf:value>41</xf:value>
  539. </xf:item>
  540. <xf:item id="42">
  541. <xf:label>John Malugu [44-8]</xf:label>
  542. <xf:value>42</xf:value>
  543. </xf:item>
  544. <xf:item id="43">
  545. <xf:label>Ivana Di Salvo [157-8]</xf:label>
  546. <xf:value>43</xf:value>
  547. </xf:item>
  548. <xf:item id="44">
  549. <xf:label>Michael Charles Kasmiri [159-4]</xf:label>
  550. <xf:value>44</xf:value>
  551. </xf:item>
  552. <xf:item id="45">
  553. <xf:label>George Frederick Mkoma [95-0]</xf:label>
  554. <xf:value>45</xf:value>
  555. </xf:item>
  556. <xf:item id="46">
  557. <xf:label>Mary Gregory Marandu [107-3]</xf:label>
  558. <xf:value>46</xf:value>
  559. </xf:item>
  560. <xf:item id="47">
  561. <xf:label>Asha Juma Haroub [13-3]</xf:label>
  562. <xf:value>47</xf:value>
  563. </xf:item>
  564. <xf:item id="48">
  565. <xf:label>Bernard Gabriel Kivuma [75-2]</xf:label>
  566. <xf:value>48</xf:value>
  567. </xf:item>
  568. <xf:item id="49">
  569. <xf:label>Jacopo Nicoletti [158-6]</xf:label>
  570. <xf:value>49</xf:value>
  571. </xf:item>
  572. <xf:item id="50">
  573. <xf:label>Slyakus Vintan Mlembe [145-3]</xf:label>
  574. <xf:value>50</xf:value>
  575. </xf:item>
  576. <xf:item id="51">
  577. <xf:label>George Frederick Sigalla [164-4]</xf:label>
  578. <xf:value>51</xf:value>
  579. </xf:item>
  580. <xf:item id="52">
  581. <xf:label>Francisca Seraphin Chuwa [165-1]</xf:label>
  582. <xf:value>52</xf:value>
  583. </xf:item>
  584. <xf:item id="53">
  585. <xf:label>Farida Bani [114-9]</xf:label>
  586. <xf:value>53</xf:value>
  587. </xf:item>
  588. <xf:item id="54">
  589. <xf:label>Yvonne Ramesh Haridas [171-9]</xf:label>
  590. <xf:value>54</xf:value>
  591. </xf:item>
  592. <xf:item id="55">
  593. <xf:label>Jacqueline Inoja Nkouabi [170-1]</xf:label>
  594. <xf:value>55</xf:value>
  595. </xf:item>
  596. <xf:item id="56">
  597. <xf:label>Suzan Ngalimecha Ngahyoma [172-7]</xf:label>
  598. <xf:value>56</xf:value>
  599. </xf:item>
  600. <xf:item id="57">
  601. <xf:label>Regina Ndaki [84-4]</xf:label>
  602. <xf:value>57</xf:value>
  603. </xf:item>
  604. <xf:item id="58">
  605. <xf:label>Sarah Katharina Staehelin [175-0]</xf:label>
  606. <xf:value>58</xf:value>
  607. </xf:item>
  608. <xf:item id="59">
  609. <xf:label>John Wigayi [61-2]</xf:label>
  610. <xf:value>59</xf:value>
  611. </xf:item>
  612. <xf:item id="60">
  613. <xf:label>Mabula John [59-6]</xf:label>
  614. <xf:value>60</xf:value>
  615. </xf:item>
  616. <xf:item id="61">
  617. <xf:label>Athuman Said Mtandanguo [64-6]</xf:label>
  618. <xf:value>61</xf:value>
  619. </xf:item>
  620. <xf:item id="62">
  621. <xf:label>Mohamed Godfrey Mbaruku [173-5]</xf:label>
  622. <xf:value>62</xf:value>
  623. </xf:item>
  624. <xf:item id="63">
  625. <xf:label>Juma Kupewa [176-8]</xf:label>
  626. <xf:value>63</xf:value>
  627. </xf:item>
  628. <xf:item id="64">
  629. <xf:label>Leila Samson [85-1]</xf:label>
  630. <xf:value>64</xf:value>
  631. </xf:item>
  632. <xf:item id="65">
  633. <xf:label>Ramadhan Katala [177-6]</xf:label>
  634. <xf:value>65</xf:value>
  635. </xf:item>
  636.  
  637. <xf:item id="67">
  638. <xf:label>Lulu Wilson Ismael [180-0]</xf:label>
  639. <xf:value>67</xf:value>
  640. </xf:item>
  641. <xf:item id="68">
  642. <xf:label>Rabson Namtwanga [181-8]</xf:label>
  643. <xf:value>68</xf:value>
  644. </xf:item>
  645. <xf:item id="69">
  646. <xf:label>Belina Byabato [182-6]</xf:label>
  647. <xf:value>69</xf:value>
  648. </xf:item>
  649. <xf:item id="70">
  650. <xf:label>Sturida Patrick [183-4]</xf:label>
  651. <xf:value>70</xf:value>
  652. </xf:item>
  653. <xf:item id="71">
  654. <xf:label>Florent Raphael Heritier [184-2]</xf:label>
  655. <xf:value>71</xf:value>
  656. </xf:item>
  657. <xf:item id="72">
  658. <xf:label>Happyphania Isaya Ngakongwa [167-7]</xf:label>
  659. <xf:value>72</xf:value>
  660. </xf:item>
  661. <xf:item id="73">
  662. <xf:label>Petro Togolani Sabuni [185-9]</xf:label>
  663. <xf:value>73</xf:value>
  664. </xf:item>
  665. <xf:item id="74">
  666. <xf:label>Cecilia Philipo Ligogo [186-7]</xf:label>
  667. <xf:value>74</xf:value>
  668. </xf:item>
  669. <xf:item id="75">
  670. <xf:label>Selerine Myeya [46-3]</xf:label>
  671. <xf:value>75</xf:value>
  672. </xf:item>
  673. <xf:item id="76">
  674. <xf:label>Namsifueli Julius Ley [187-5]</xf:label>
  675. <xf:value>76</xf:value>
  676. </xf:item>
  677. <xf:item id="77">
  678. <xf:label>Bedran Topyurek [188-3]</xf:label>
  679. <xf:value>77</xf:value>
  680. </xf:item>
  681. <xf:item id="78">
  682. <xf:label>Edgar Enzigard Martin [189-1]</xf:label>
  683. <xf:value>78</xf:value>
  684. </xf:item>
  685. <xf:item id="79">
  686. <xf:label>Fredy Geiger [190-9]</xf:label>
  687. <xf:value>79</xf:value>
  688. </xf:item>
  689. <xf:item id="3">
  690. <xf:label>Herry Robert Mapesi [14]</xf:label>
  691. <xf:value>3</xf:value>
  692. </xf:item>
  693. <xf:item id="1"><xf:label>Claudio Zaugg [12]</xf:label><xf:value>1</xf:value></xf:item><xf:item id="2"><xf:label>Lucas Gervas Shayo [13]</xf:label><xf:value>2</xf:value></xf:item><xf:item id="4"><xf:label>Agata Correia Agata [3]</xf:label><xf:value>4</xf:value></xf:item><xf:item id="5"><xf:label>Maja Weisser</xf:label><xf:value>5</xf:value></xf:item><xf:item id="6"><xf:label>Herry Robert Mapesi</xf:label><xf:value>6</xf:value></xf:item><xf:item id="7"><xf:label>George Rocky Sikalengo</xf:label><xf:value>7</xf:value></xf:item><xf:item id="8"><xf:label>ANDREW KATENDE</xf:label><xf:value>8</xf:value></xf:item><xf:item id="9"><xf:label>Robert Christopher Ndege</xf:label><xf:value>9</xf:value></xf:item><xf:item id="10"><xf:label>Getrud Joseph Mollel</xf:label><xf:value>10</xf:value></xf:item><xf:item id="11"><xf:label>Ezekiel Luoga</xf:label><xf:value>11</xf:value></xf:item><xf:item id="12"><xf:label>Lilian Moshi</xf:label><xf:value>12</xf:value></xf:item><xf:item id="13"><xf:label>Vanesa Anton Vazquez</xf:label><xf:value>13</xf:value></xf:item><xf:item id="14"><xf:label>Rahel Bircher</xf:label><xf:value>14</xf:value></xf:item><xf:item id="15"><xf:label>Gidion Fue</xf:label><xf:value>15</xf:value></xf:item><xf:item id="16"><xf:label>Athuman Mtandanguo</xf:label><xf:value>16</xf:value></xf:item><xf:item id="17"><xf:label>Specioza Hwaya</xf:label><xf:value>17</xf:value></xf:item><xf:item id="18"><xf:label>Armon Arpagaus</xf:label><xf:value>18</xf:value></xf:item><xf:item id="19"><xf:label>Sambuta Aloyce [125-5]</xf:label><xf:value>19</xf:value></xf:item><xf:item id="20"><xf:label>Anna Eichenberger [129-7]</xf:label><xf:value>20</xf:value></xf:item><xf:item id="21"><xf:label>Felister Godson Kiwelu</xf:label><xf:value>21</xf:value></xf:item><xf:item id="22"><xf:label>Phamarcy CDCI [132-1]</xf:label><xf:value>22</xf:value></xf:item><xf:item id="23"><xf:label>Pharmacy one Stop [133-9]</xf:label><xf:value>23</xf:value></xf:item><xf:item id="24"><xf:label>Linn Jarte</xf:label><xf:value>24</xf:value></xf:item><xf:item id="25"><xf:label>Omary Ngome Rajab [137-0]</xf:label><xf:value>25</xf:value></xf:item><xf:item id="26"><xf:label>Laura Gimenez Letona [139-6]</xf:label><xf:value>26</xf:value></xf:item><xf:item id="27"><xf:label>Herieth wilson ismael [140-4]</xf:label><xf:value>27</xf:value></xf:item><xf:item id="28"><xf:label>Selerine John Myeya [60-4]</xf:label><xf:value>28</xf:value></xf:item><xf:item id="29"><xf:label>PHILIP SCHMASSMANN [141-2]</xf:label><xf:value>29</xf:value></xf:item><xf:item id="30"><xf:label>Elizabeth Eliet Senkoro [142-0]</xf:label><xf:value>30</xf:value></xf:item><xf:item id="31"><xf:label>Vera Hodel [143-8]</xf:label><xf:value>31</xf:value></xf:item><xf:item id="32"><xf:label>Joshua Joseph Kapungu [144-6]</xf:label><xf:value>32</xf:value></xf:item><xf:item id="33"><xf:label>Andre Hofer [146-1]</xf:label><xf:value>33</xf:value></xf:item><xf:item id="35"><xf:label>James Okuma [148-7]</xf:label><xf:value>35</xf:value></xf:item><xf:item id="36"><xf:label>Sandra Glauser [149-5]</xf:label><xf:value>36</xf:value></xf:item><xf:item id="37"><xf:label>Raphael Magnolini [151-1]</xf:label><xf:value>37</xf:value></xf:item><xf:item id="38"><xf:label>Olivia John Kitau [152-9]</xf:label><xf:value>38</xf:value></xf:item><xf:item id="39"><xf:label>Alois Mbuta [153-7]</xf:label><xf:value>39</xf:value></xf:item><xf:item id="40"><xf:label>Paul Camille Genton [154-5]</xf:label><xf:value>40</xf:value></xf:item><xf:item id="41"><xf:label>Evarist Chiweka [19-0]</xf:label><xf:value>41</xf:value></xf:item><xf:item id="42"><xf:label>John Malugu [44-8]</xf:label><xf:value>42</xf:value></xf:item><xf:item id="43"><xf:label>Ivana Di Salvo [157-8]</xf:label><xf:value>43</xf:value></xf:item><xf:item id="44"><xf:label>Michael Charles Kasmiri [159-4]</xf:label><xf:value>44</xf:value></xf:item><xf:item id="45"><xf:label>George Frederick Mkoma [95-0]</xf:label><xf:value>45</xf:value></xf:item><xf:item id="46"><xf:label>Mary Gregory Marandu [107-3]</xf:label><xf:value>46</xf:value></xf:item><xf:item id="47"><xf:label>Asha Juma Haroub [13-3]</xf:label><xf:value>47</xf:value></xf:item><xf:item id="48"><xf:label>Bernard Gabriel Kivuma [75-2]</xf:label><xf:value>48</xf:value></xf:item><xf:item id="49"><xf:label>Jacopo Nicoletti [158-6]</xf:label><xf:value>49</xf:value></xf:item><xf:item id="50"><xf:label>Slyakus Vintan Mlembe [145-3]</xf:label><xf:value>50</xf:value></xf:item><xf:item id="51"><xf:label>George Frederick Sigalla [164-4]</xf:label><xf:value>51</xf:value></xf:item><xf:item id="52"><xf:label>Francisca Seraphin Chuwa [165-1]</xf:label><xf:value>52</xf:value></xf:item><xf:item id="53"><xf:label>Farida Bani [114-9]</xf:label><xf:value>53</xf:value></xf:item><xf:item id="54"><xf:label>Yvonne Ramesh Haridas [171-9]</xf:label><xf:value>54</xf:value></xf:item><xf:item id="55"><xf:label>Jacqueline Inoja Nkouabi [170-1]</xf:label><xf:value>55</xf:value></xf:item><xf:item id="56"><xf:label>Suzan Ngalimecha Ngahyoma [172-7]</xf:label><xf:value>56</xf:value></xf:item><xf:item id="57"><xf:label>Regina Ndaki [84-4]</xf:label><xf:value>57</xf:value></xf:item><xf:item id="58"><xf:label>Sarah Katharina Staehelin [175-0]</xf:label><xf:value>58</xf:value></xf:item><xf:item id="59"><xf:label>John Wigayi [61-2]</xf:label><xf:value>59</xf:value></xf:item><xf:item id="60"><xf:label>Mabula John [59-6]</xf:label><xf:value>60</xf:value></xf:item><xf:item id="61"><xf:label>Athuman Said Mtandanguo [64-6]</xf:label><xf:value>61</xf:value></xf:item><xf:item id="62"><xf:label>Mohamed Godfrey Mbaruku [173-5]</xf:label><xf:value>62</xf:value></xf:item><xf:item id="63"><xf:label>Juma Kupewa [176-8]</xf:label><xf:value>63</xf:value></xf:item><xf:item id="64"><xf:label>Leila Samson [85-1]</xf:label><xf:value>64</xf:value></xf:item><xf:item id="65"><xf:label>Ramadhan Katala [177-6]</xf:label><xf:value>65</xf:value></xf:item><xf:item id="66"><xf:label>Elizabeth Dotto Kagwese [179-2]</xf:label><xf:value>66</xf:value></xf:item><xf:item id="67"><xf:label>Lulu Wilson Ismael [180-0]</xf:label><xf:value>67</xf:value></xf:item><xf:item id="68"><xf:label>Rabson Namtwanga [181-8]</xf:label><xf:value>68</xf:value></xf:item><xf:item id="69"><xf:label>Belina Byabato [182-6]</xf:label><xf:value>69</xf:value></xf:item><xf:item id="70"><xf:label>Sturida Patrick [183-4]</xf:label><xf:value>70</xf:value></xf:item><xf:item id="71"><xf:label>Florent Raphael Heritier [184-2]</xf:label><xf:value>71</xf:value></xf:item><xf:item id="72"><xf:label>Happyphania Isaya Ngakongwa [167-7]</xf:label><xf:value>72</xf:value></xf:item><xf:item id="3"><xf:label>Herry Robert Mapesi [14]</xf:label><xf:value>3</xf:value></xf:item><xf:item id="174"><xf:label>Jerome Lwali [174]</xf:label><xf:value>174</xf:value></xf:item><xf:item id="173"><xf:label>Mohamed Godfrey Mbaruku [173]</xf:label><xf:value>173</xf:value></xf:item><xf:item id="171"><xf:label>Yvonne Ramesh Haridas [171]</xf:label><xf:value>171</xf:value></xf:item><xf:item id="165"><xf:label>Francisca Seraphin Chuwa [165]</xf:label><xf:value>165</xf:value></xf:item><xf:item id="111"><xf:label>Robert Christopher Ndege [111]</xf:label><xf:value>111</xf:value></xf:item><xf:item id="125"><xf:label>Sambuta Aloyce [125]</xf:label><xf:value>125</xf:value></xf:item><xf:item id="87"><xf:label>Leila Samson [87]</xf:label><xf:value>87</xf:value></xf:item><xf:item id="170"><xf:label>Jacqueline Inoja Nkouabi [170]</xf:label><xf:value>170</xf:value></xf:item><xf:item id="178"><xf:label>Deogratius Nzaligo [178]</xf:label><xf:value>178</xf:value></xf:item><xf:item id="179"><xf:label>Elizabeth Dotto Kagwese [179]</xf:label><xf:value>179</xf:value></xf:item><xf:item id="180"><xf:label>Lulu Wilson Ismael [180]</xf:label><xf:value>180</xf:value></xf:item><xf:item id="117"><xf:label>Lilian Moshi [117]</xf:label><xf:value>117</xf:value></xf:item><xf:item id="105"><xf:label>Ezekiel Luoga [105]</xf:label><xf:value>105</xf:value></xf:item><xf:item id="181"><xf:label>Rabson Namtwanga [181]</xf:label><xf:value>181</xf:value></xf:item><xf:item id="184"><xf:label>Florent Raphael Heritier [184]</xf:label><xf:value>184</xf:value></xf:item><xf:item id="167"><xf:label>Happyphania Isaya Ngakongwa [167]</xf:label><xf:value>167</xf:value></xf:item><xf:item id="86"><xf:label>Regina Ndaki [86]</xf:label><xf:value>86</xf:value></xf:item><xf:item id="100"><xf:label>Maja Weisser [100]</xf:label><xf:value>100</xf:value></xf:item><xf:item id="106"><xf:label>Sharifa Nakapala [106]</xf:label><xf:value>106</xf:value></xf:item><xf:item id="185"><xf:label>Petro Togolani Sabuni [185]</xf:label><xf:value>185</xf:value></xf:item><xf:item id="187"><xf:label>Namsifueli Julius Ley [187]</xf:label><xf:value>187</xf:value></xf:item><xf:item id="188"><xf:label>Bedran Topyurek [188]</xf:label><xf:value>188</xf:value></xf:item><xf:item id="190"><xf:label>Fredy Geiger [190]</xf:label><xf:value>190</xf:value></xf:item><xf:item id="176"><xf:label>Juma Kupewa [176]</xf:label><xf:value>176</xf:value></xf:item><xf:item id="193"><xf:label>Getruda Lenia Julius [193]</xf:label><xf:value>193</xf:value></xf:item><xf:item id="194"><xf:label>Florian Kasper Mury [194]</xf:label><xf:value>194</xf:value></xf:item><xf:item id="195"><xf:label>Sara Glanzmann [195]</xf:label><xf:value>195</xf:value></xf:item><xf:item id="196"><xf:label>Benjamin Yannick Bissmann [196]</xf:label><xf:value>196</xf:value></xf:item><xf:item id="172"><xf:label>Suzan Ngalimecha Ngahyoma [172]</xf:label><xf:value>172</xf:value></xf:item><xf:item id="197"><xf:label>Emanuel Ally Nyenza [197]</xf:label><xf:value>197</xf:value></xf:item><xf:item id="198"><xf:label>Franzisca Alfred Mmbando [198]</xf:label><xf:value>198</xf:value></xf:item><xf:item id="116"><xf:label>Farida Bani [116]</xf:label><xf:value>116</xf:value></xf:item></xf:select1>
  694. <xf:input bind="group_therapy_-_notes">
  695. <xf:label>Group Therapy - Notes</xf:label>
  696. <xf:hint>Group Therapy - Notes</xf:hint>
  697. </xf:input><xf:input bind="number_of_sessions_-_group_therapy">
  698. <xf:label>Number of Sessions - Group Therapy</xf:label>
  699. <xf:hint>Number of sessions at 6-12 months</xf:hint>
  700. </xf:input><xf:select1 bind="group_therapy_status">
  701. <xf:label>Group Therapy Status</xf:label>
  702. <xf:hint>Determines whether group therapy was done or not</xf:hint>
  703. <xf:item concept_id="162813" id="162787^Done^99DCT">
  704. <xf:label>Done</xf:label>
  705. <xf:value>162787^Done^99DCT</xf:value>
  706. </xf:item>
  707. <xf:item concept_id="162813" id="1118^Not done^99DCT">
  708. <xf:label>Not done</xf:label>
  709. <xf:value>1118^Not done^99DCT</xf:value>
  710. </xf:item>
  711. </xf:select1><xf:input bind="depression_questionnaire_-_notes">
  712. <xf:label>Depression Questionnaire - Notes</xf:label>
  713. <xf:hint>Depression Questionnaire - Notes</xf:hint>
  714. </xf:input><xf:input bind="depression_score">
  715. <xf:label>Depression Score</xf:label>
  716. <xf:hint>Total score - Depression</xf:hint>
  717. </xf:input><xf:select1 bind="depression_questionnaires_status">
  718. <xf:label>Depression Questionnaires Status</xf:label>
  719. <xf:hint>Determines whether Depression Questionnaies were done or not</xf:hint>
  720. <xf:item concept_id="162810" id="162787^Done^99DCT">
  721. <xf:label>Done</xf:label>
  722. <xf:value>162787^Done^99DCT</xf:value>
  723. </xf:item>
  724. <xf:item concept_id="162810" id="1118^Not done^99DCT">
  725. <xf:label>Not done</xf:label>
  726. <xf:value>1118^Not done^99DCT</xf:value>
  727. </xf:item>
  728. </xf:select1><xf:input bind="stigma_video_-_notes">
  729. <xf:label>Stigma Video - Notes</xf:label>
  730. <xf:hint>Stigma Video - Notes</xf:hint>
  731. </xf:input><xf:select1 bind="stigma_video_status">
  732. <xf:label>Stigma Video Status</xf:label>
  733. <xf:hint>Stigma Video Status</xf:hint>
  734. <xf:item concept_id="162808" id="162787^Done^99DCT">
  735. <xf:label>Done</xf:label>
  736. <xf:value>162787^Done^99DCT</xf:value>
  737. </xf:item>
  738. <xf:item concept_id="162808" id="1118^Not done^99DCT">
  739. <xf:label>Not done</xf:label>
  740. <xf:value>1118^Not done^99DCT</xf:value>
  741. </xf:item>
  742. </xf:select1><xf:input bind="stigma_questionnaire_-_notes">
  743. <xf:label>Stigma Questionnaire - Notes</xf:label>
  744. <xf:hint>Stigma Questionnaire - Notes</xf:hint>
  745. </xf:input><xf:input bind="total_score_-_stigma_questionnaire">
  746. <xf:label>Total Score - Stigma Questionnaire</xf:label>
  747. <xf:hint>Total score - Stigma questionnaire</xf:hint>
  748. </xf:input><xf:select1 bind="stigma_questionnaires_status">
  749. <xf:label>Stigma Questionnaires Status</xf:label>
  750. <xf:hint>Determines whether stigma Questionnaireswere done or not</xf:hint>
  751. <xf:item concept_id="162805" id="162787^Done^99DCT">
  752. <xf:label>Done</xf:label>
  753. <xf:value>162787^Done^99DCT</xf:value>
  754. </xf:item>
  755. <xf:item concept_id="162805" id="1118^Not done^99DCT">
  756. <xf:label>Not done</xf:label>
  757. <xf:value>1118^Not done^99DCT</xf:value>
  758. </xf:item>
  759. </xf:select1><xf:select1 bind="questionnaires_status">
  760. <xf:label>Questionnaires Status</xf:label>
  761. <xf:hint>Determines whether Questionaires were done or not</xf:hint>
  762. <xf:item concept_id="162804" id="162787^Done^99DCT">
  763. <xf:label>Done</xf:label>
  764. <xf:value>162787^Done^99DCT</xf:value>
  765. </xf:item>
  766. <xf:item concept_id="162804" id="1118^Not done^99DCT">
  767. <xf:label>Not done</xf:label>
  768. <xf:value>1118^Not done^99DCT</xf:value>
  769. </xf:item>
  770. </xf:select1><xf:input bind="counselling_notes">
  771. <xf:label>Counselling Notes</xf:label>
  772. <xf:hint>Notes/Observations taken in the Counselling section</xf:hint>
  773. </xf:input><xf:input bind="others_-_counselling_section">
  774. <xf:label>Others - Counselling Section</xf:label>
  775. <xf:hint>Specify other counsellings</xf:hint>
  776. </xf:input><xf:select1 bind="other_counselling_purpose">
  777. <xf:label>Other Counselling Purpose</xf:label>
  778. <xf:hint>Other Counselling Purpose</xf:hint>
  779. <xf:item concept_id="162801" id="162787^Done^99DCT">
  780. <xf:label>Done</xf:label>
  781. <xf:value>162787^Done^99DCT</xf:value>
  782. </xf:item>
  783. <xf:item concept_id="162801" id="1118^Not done^99DCT">
  784. <xf:label>Not done</xf:label>
  785. <xf:value>1118^Not done^99DCT</xf:value>
  786. </xf:item>
  787. </xf:select1><xf:select1 bind="prep_counselling">
  788. <xf:label>PrEP Counselling</xf:label>
  789. <xf:hint>PrEP Counselling</xf:hint>
  790. <xf:item concept_id="162800" id="162787^Done^99DCT">
  791. <xf:label>Done</xf:label>
  792. <xf:value>162787^Done^99DCT</xf:value>
  793. </xf:item>
  794. <xf:item concept_id="162800" id="1118^Not done^99DCT">
  795. <xf:label>Not done</xf:label>
  796. <xf:value>1118^Not done^99DCT</xf:value>
  797. </xf:item>
  798. </xf:select1><xf:select1 bind="disclosure_counselling">
  799. <xf:label>Disclosure Counselling</xf:label>
  800. <xf:hint>Disclosure Counselling</xf:hint>
  801. <xf:item concept_id="162799" id="162797^Partial Disclosure^99DCT">
  802. <xf:label>Partial Disclosure</xf:label>
  803. <xf:value>162797^Partial Disclosure^99DCT</xf:value>
  804. </xf:item>
  805. <xf:item concept_id="162799" id="162798^Full Disclosure^99DCT">
  806. <xf:label>Full Disclosure</xf:label>
  807. <xf:value>162798^Full Disclosure^99DCT</xf:value>
  808. </xf:item>
  809. </xf:select1><xf:select1 bind="pmtct_counselling">
  810. <xf:label>PMTCT Counselling</xf:label>
  811. <xf:hint>PMTCT Counselling</xf:hint>
  812. <xf:item concept_id="162796" id="162787^Done^99DCT">
  813. <xf:label>Done</xf:label>
  814. <xf:value>162787^Done^99DCT</xf:value>
  815. </xf:item>
  816. <xf:item concept_id="162796" id="1118^Not done^99DCT">
  817. <xf:label>Not done</xf:label>
  818. <xf:value>1118^Not done^99DCT</xf:value>
  819. </xf:item>
  820. </xf:select1><xf:select1 bind="lay_counselling">
  821. <xf:label>Lay Counselling</xf:label>
  822. <xf:hint>Lay Counselling</xf:hint>
  823. <xf:item concept_id="162795" id="162787^Done^99DCT">
  824. <xf:label>Done</xf:label>
  825. <xf:value>162787^Done^99DCT</xf:value>
  826. </xf:item>
  827. <xf:item concept_id="162795" id="1118^Not done^99DCT">
  828. <xf:label>Not done</xf:label>
  829. <xf:value>1118^Not done^99DCT</xf:value>
  830. </xf:item>
  831. </xf:select1><xf:select1 bind="adherence_counselling">
  832. <xf:label>Adherence Counselling</xf:label>
  833. <xf:hint>Adherence Counselling</xf:hint>
  834. <xf:item concept_id="162794" id="162787^Done^99DCT">
  835. <xf:label>Done</xf:label>
  836. <xf:value>162787^Done^99DCT</xf:value>
  837. </xf:item>
  838. <xf:item concept_id="162794" id="1118^Not done^99DCT">
  839. <xf:label>Not done</xf:label>
  840. <xf:value>1118^Not done^99DCT</xf:value>
  841. </xf:item>
  842. </xf:select1><xf:select1 bind="enhanced_adherence_counselling">
  843. <xf:label>Enhanced Adherence Counselling</xf:label>
  844. <xf:hint>Enhanced Adherence Counselling</xf:hint>
  845. <xf:item concept_id="162793" id="162789^First Session^99DCT">
  846. <xf:label>First Session</xf:label>
  847. <xf:value>162789^First Session^99DCT</xf:value>
  848. </xf:item>
  849. <xf:item concept_id="162793" id="162790^Second Session^99DCT">
  850. <xf:label>Second Session</xf:label>
  851. <xf:value>162790^Second Session^99DCT</xf:value>
  852. </xf:item>
  853. <xf:item concept_id="162793" id="162791^Third Session^99DCT">
  854. <xf:label>Third Session</xf:label>
  855. <xf:value>162791^Third Session^99DCT</xf:value>
  856. </xf:item>
  857. </xf:select1><xf:select1 bind="pre-art_counselling">
  858. <xf:label>Pre-ART Counselling</xf:label>
  859. <xf:hint>Counselling before starting ART</xf:hint>
  860. <xf:item concept_id="162792" id="162789^First Session^99DCT">
  861. <xf:label>First Session</xf:label>
  862. <xf:value>162789^First Session^99DCT</xf:value>
  863. </xf:item>
  864. <xf:item concept_id="162792" id="162790^Second Session^99DCT">
  865. <xf:label>Second Session</xf:label>
  866. <xf:value>162790^Second Session^99DCT</xf:value>
  867. </xf:item>
  868. <xf:item concept_id="162792" id="162791^Third Session^99DCT">
  869. <xf:label>Third Session</xf:label>
  870. <xf:value>162791^Third Session^99DCT</xf:value>
  871. </xf:item>
  872. </xf:select1><xf:select1 bind="counselling_status">
  873. <xf:label>Counselling Status</xf:label>
  874. <xf:hint>Determines whether counselling was done or not</xf:hint>
  875. <xf:item concept_id="162788" id="162787^Done^99DCT">
  876. <xf:label>Done</xf:label>
  877. <xf:value>162787^Done^99DCT</xf:value>
  878. </xf:item>
  879. <xf:item concept_id="162788" id="1118^Not done^99DCT">
  880. <xf:label>Not done</xf:label>
  881. <xf:value>1118^Not done^99DCT</xf:value>
  882. </xf:item>
  883. </xf:select1><xf:group id="patient/patient_relative">
  884. <xf:label>RELATIONSHIPS</xf:label>
  885. <xf:hint>Relationships that this patient has.</xf:hint>
  886. <xf:repeat bind="patient_relative">
  887.  
  888. <xf:input bind="patient_relative.person">
  889. <xf:label>RELATIVE</xf:label>
  890. </xf:input>
  891.  
  892. <xf:select1 bind="patient_relative.relationship">
  893. <xf:item id="1A">
  894. <xf:label>is Doctor [1]</xf:label>
  895. <xf:value>1A</xf:value>
  896. </xf:item>
  897. <xf:item id="1B">
  898. <xf:label>is Patient [1]</xf:label>
  899. <xf:value>1B</xf:value>
  900. </xf:item>
  901. <xf:item id="2A">
  902. <xf:label>is Sibling [2]</xf:label>
  903. <xf:value>2A</xf:value>
  904. </xf:item>
  905. <xf:item id="3A">
  906. <xf:label>is Parent [3]</xf:label>
  907. <xf:value>3A</xf:value>
  908. </xf:item>
  909. <xf:item id="3B">
  910. <xf:label>is Child [3]</xf:label>
  911. <xf:value>3B</xf:value>
  912. </xf:item>
  913. <xf:item id="4A">
  914. <xf:label>is Aunt/Uncle [4]</xf:label>
  915. <xf:value>4A</xf:value>
  916. </xf:item>
  917. <xf:item id="4B">
  918. <xf:label>is Niece/Nephew [4]</xf:label>
  919. <xf:value>4B</xf:value>
  920. </xf:item>
  921. <xf:label>RELATIONSHIP</xf:label>
  922. </xf:select1>
  923. </xf:repeat>
  924. </xf:group><xf:input bind="yes_controlling">
  925. <xf:label>YES_CONTROLLING</xf:label>
  926. <xf:hint>Are you afraid of anyone of the people you mention above?</xf:hint>
  927. </xf:input><xf:select1 bind="controlling">
  928. <xf:label>CONTROLLING</xf:label>
  929. <xf:hint>In the past 12 months, has your (current or most recent) husband/partner controlled who to see or talk to, restricted contact with your family and where to go or what to do, forcing you to do anything you do not want to do or controlled your sources of income?</xf:hint>
  930. <xf:item concept_id="163112" id="1066^NO^99DCT">
  931. <xf:label>NO</xf:label>
  932. <xf:value>1066^NO^99DCT</xf:value>
  933. </xf:item>
  934. <xf:item concept_id="163112" id="1065^YES^99DCT">
  935. <xf:label>YES</xf:label>
  936. <xf:value>1065^YES^99DCT</xf:value>
  937. </xf:item>
  938. </xf:select1><xf:input bind="yes_verbal">
  939. <xf:label>YES_VERBAL</xf:label>
  940. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  941. </xf:input><xf:select1 bind="verbal">
  942. <xf:label>VERBAL</xf:label>
  943. <xf:hint>In the past 12 months, have anyone insulted or humiliated or yelled at you or verbally threated to hurt you or someone you care about?</xf:hint>
  944. <xf:item concept_id="163110" id="1066^NO^99DCT">
  945. <xf:label>NO</xf:label>
  946. <xf:value>1066^NO^99DCT</xf:value>
  947. </xf:item>
  948. <xf:item concept_id="163110" id="1065^YES^99DCT">
  949. <xf:label>YES</xf:label>
  950. <xf:value>1065^YES^99DCT</xf:value>
  951. </xf:item>
  952. </xf:select1><xf:input bind="yes_force_abort">
  953. <xf:label>YES_FORCE_ABORT</xf:label>
  954. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  955. </xf:input><xf:select1 bind="force_abort">
  956. <xf:label>FORCE_ABORT</xf:label>
  957. <xf:hint>In the past 12 months, were you coerced or forced to have an abortion?</xf:hint>
  958. <xf:item concept_id="163108" id="1066^NO^99DCT">
  959. <xf:label>NO</xf:label>
  960. <xf:value>1066^NO^99DCT</xf:value>
  961. </xf:item>
  962. <xf:item concept_id="163108" id="1065^YES^99DCT">
  963. <xf:label>YES</xf:label>
  964. <xf:value>1065^YES^99DCT</xf:value>
  965. </xf:item>
  966. </xf:select1><xf:input bind="yes_force_marriage">
  967. <xf:label>YES_FORCE_MARRIAGE</xf:label>
  968. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  969. </xf:input><xf:select1 bind="forced_marriage">
  970. <xf:label>FORCED_MARRIAGE</xf:label>
  971. <xf:hint>In the past 12 months, were you coerced or forced into marriage?</xf:hint>
  972. <xf:item concept_id="163106" id="1066^NO^99DCT">
  973. <xf:label>NO</xf:label>
  974. <xf:value>1066^NO^99DCT</xf:value>
  975. </xf:item>
  976. <xf:item concept_id="163106" id="1065^YES^99DCT">
  977. <xf:label>YES</xf:label>
  978. <xf:value>1065^YES^99DCT</xf:value>
  979. </xf:item>
  980. </xf:select1><xf:input bind="yes_unwill_preg">
  981. <xf:label>YES_UNWILL_PREG</xf:label>
  982. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  983. </xf:input><xf:select1 bind="unwill_preg">
  984. <xf:label>UNWILL_PREG</xf:label>
  985. <xf:hint>In the past 12 months, were you physically forced or made to feel that you had to become pregnant against your will?</xf:hint>
  986. <xf:item concept_id="163104" id="1066^NO^99DCT">
  987. <xf:label>NO</xf:label>
  988. <xf:value>1066^NO^99DCT</xf:value>
  989. </xf:item>
  990. <xf:item concept_id="163104" id="1065^YES^99DCT">
  991. <xf:label>YES</xf:label>
  992. <xf:value>1065^YES^99DCT</xf:value>
  993. </xf:item>
  994. </xf:select1><xf:input bind="yes_danger_sex">
  995. <xf:label>YES_DANGER_SEX</xf:label>
  996. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  997. </xf:input><xf:select1 bind="danger_sex">
  998. <xf:label>DANGER_SEX</xf:label>
  999. <xf:hint>In the past 12 months, were you forced to have sex to be able to eat, have shelter, or have sex for essential services (such as protection or school) because you or someone in your family would be in physical danger if you refused?</xf:hint>
  1000. <xf:item concept_id="163102" id="1066^NO^99DCT">
  1001. <xf:label>NO</xf:label>
  1002. <xf:value>1066^NO^99DCT</xf:value>
  1003. </xf:item>
  1004. <xf:item concept_id="163102" id="1065^YES^99DCT">
  1005. <xf:label>YES</xf:label>
  1006. <xf:value>1065^YES^99DCT</xf:value>
  1007. </xf:item>
  1008. </xf:select1><xf:input bind="yes_unwill_sex">
  1009. <xf:label>YES_UNWILL_SEX</xf:label>
  1010. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  1011. </xf:input><xf:select1 bind="unwill_sex">
  1012. <xf:label>UNWILL_SEX</xf:label>
  1013. <xf:hint>In the past 12 months, were you forced to have sex against your will?</xf:hint>
  1014. <xf:item concept_id="163100" id="1066^NO^99DCT">
  1015. <xf:label>NO</xf:label>
  1016. <xf:value>1066^NO^99DCT</xf:value>
  1017. </xf:item>
  1018. <xf:item concept_id="163100" id="1065^YES^99DCT">
  1019. <xf:label>YES</xf:label>
  1020. <xf:value>1065^YES^99DCT</xf:value>
  1021. </xf:item>
  1022. </xf:select1><xf:input bind="yes_physical">
  1023. <xf:label>YES_PHYSICAL</xf:label>
  1024. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  1025. </xf:input><xf:select1 bind="physical">
  1026. <xf:label>PHYSICAL</xf:label>
  1027. <xf:hint>In the past 12 months, have you been hit, punched, kicked, slapped, choked, hurt with a weapon, or otherwise physically hurt by someone in your home or outside of your house?</xf:hint>
  1028. <xf:item concept_id="163098" id="1066^NO^99DCT">
  1029. <xf:label>NO</xf:label>
  1030. <xf:value>1066^NO^99DCT</xf:value>
  1031. </xf:item>
  1032. <xf:item concept_id="163098" id="1065^YES^99DCT">
  1033. <xf:label>YES</xf:label>
  1034. <xf:value>1065^YES^99DCT</xf:value>
  1035. </xf:item>
  1036. </xf:select1><xf:input bind="yes_emotional">
  1037. <xf:label>YES_EMOTIONAL</xf:label>
  1038. <xf:hint>If yes, by whom (relationship not a name)</xf:hint>
  1039. </xf:input><xf:select1 bind="emotional">
  1040. <xf:label>EMOTIONAL</xf:label>
  1041. <xf:hint>In the past 12 months, have you been emotionally or threatened with physical or sexual violence by someone in your home or outside of your home?</xf:hint>
  1042. <xf:item concept_id="163096" id="1066^NO^99DCT">
  1043. <xf:label>NO</xf:label>
  1044. <xf:value>1066^NO^99DCT</xf:value>
  1045. </xf:item>
  1046. <xf:item concept_id="163096" id="1065^YES^99DCT">
  1047. <xf:label>YES</xf:label>
  1048. <xf:value>1065^YES^99DCT</xf:value>
  1049. </xf:item>
  1050. </xf:select1><xf:select1 bind="gbv_any">
  1051. <xf:label>GBV_ANY</xf:label>
  1052. <xf:hint>In the past 12 months did you experience any GBV?</xf:hint>
  1053. <xf:item concept_id="163095" id="1066^NO^99DCT">
  1054. <xf:label>NO</xf:label>
  1055. <xf:value>1066^NO^99DCT</xf:value>
  1056. </xf:item>
  1057. <xf:item concept_id="163095" id="1065^YES^99DCT">
  1058. <xf:label>YES</xf:label>
  1059. <xf:value>1065^YES^99DCT</xf:value>
  1060. </xf:item>
  1061. </xf:select1><xf:select1 bind="gbv_screen">
  1062. <xf:label>GBV_SCREEN</xf:label>
  1063. <xf:hint>Patient screened for GBV? If yes, respond YES/NO to the following questions</xf:hint>
  1064. <xf:item concept_id="163090" id="1066^NO^99DCT">
  1065. <xf:label>NO</xf:label>
  1066. <xf:value>1066^NO^99DCT</xf:value>
  1067. </xf:item>
  1068. <xf:item concept_id="163090" id="1065^YES^99DCT">
  1069. <xf:label>YES</xf:label>
  1070. <xf:value>1065^YES^99DCT</xf:value>
  1071. </xf:item>
  1072. </xf:select1><xf:select1 bind="visitect_res">
  1073. <xf:label>VISITECT_RES</xf:label>
  1074. <xf:hint>Visitect (Rapid CD4) results</xf:hint>
  1075. <xf:item concept_id="163119" id="163116^&amp;lt;= 200 CD4 T cells/microL^99DCT">
  1076. <xf:label>&lt;= 200 CD4 T cells/microL</xf:label>
  1077. <xf:value>163116^&amp;lt;= 200 CD4 T cells/microL^99DCT</xf:value>
  1078. </xf:item>
  1079. <xf:item concept_id="163119" id="163117^&amp;gt; 200 CD4 T cells/microL^99DCT">
  1080. <xf:label>&gt; 200 CD4 T cells/microL</xf:label>
  1081. <xf:value>163117^&amp;gt; 200 CD4 T cells/microL^99DCT</xf:value>
  1082. </xf:item>
  1083. <xf:item concept_id="163119" id="163118^Invalid result^99DCT">
  1084. <xf:label>Invalid result</xf:label>
  1085. <xf:value>163118^Invalid result^99DCT</xf:value>
  1086. </xf:item>
  1087. </xf:select1><xf:select1 bind="visitect">
  1088. <xf:label>VISITECT</xf:label>
  1089. <xf:hint>Was Visitect (Rapid CD4) done today?</xf:hint>
  1090. <xf:item concept_id="163115" id="1066^NO^99DCT">
  1091. <xf:label>NO</xf:label>
  1092. <xf:value>1066^NO^99DCT</xf:value>
  1093. </xf:item>
  1094. <xf:item concept_id="163115" id="1065^YES^99DCT">
  1095. <xf:label>YES</xf:label>
  1096. <xf:value>1065^YES^99DCT</xf:value>
  1097. </xf:item>
  1098. </xf:select1><xf:select1 bind="if_partner_is_tested_negative_prep_service">
  1099. <xf:label>If Partner is tested Negative, PrEP service</xf:label>
  1100. <xf:hint>If Partner is tested Negative, PrEP service</xf:hint>
  1101. <xf:item concept_id="163188" id="163186^Started^99DCT">
  1102. <xf:label>Started</xf:label>
  1103. <xf:value>163186^Started^99DCT</xf:value>
  1104. </xf:item>
  1105. <xf:item concept_id="163188" id="163187^Not started^99DCT">
  1106. <xf:label>Not started</xf:label>
  1107. <xf:value>163187^Not started^99DCT</xf:value>
  1108. </xf:item>
  1109. </xf:select1>
  1110. <xf:input bind="if_yes_enter_the_nacp_number">
  1111. <xf:label>If Yes, enter the NACP number</xf:label>
  1112. <xf:hint>If Yes, enter the NACP number</xf:hint>
  1113. </xf:input>
  1114. <xf:select1 bind="if_positive_does_he_or_she_enrolled_in_kiularco">
  1115. <xf:label>If Positive, does he or she enrolled in KIULARCO?</xf:label>
  1116. <xf:hint>If Positive, does he or she enrolled in KIULARCO?</xf:hint>
  1117. <xf:item concept_id="163184" id="1065^YES^99DCT">
  1118. <xf:label>YES</xf:label>
  1119. <xf:value>1065^YES^99DCT</xf:value>
  1120. </xf:item>
  1121. <xf:item concept_id="163184" id="1066^NO^99DCT">
  1122. <xf:label>NO</xf:label>
  1123. <xf:value>1066^NO^99DCT</xf:value>
  1124. </xf:item>
  1125. </xf:select1>
  1126. <xf:select1 bind="partner_result">
  1127. <xf:label>Partner result</xf:label>
  1128. <xf:hint>Partner result</xf:hint>
  1129. <xf:item concept_id="163183" id="664^NEGATIVE^99DCT">
  1130. <xf:label>NEGATIVE</xf:label>
  1131. <xf:value>664^NEGATIVE^99DCT</xf:value>
  1132. </xf:item>
  1133. <xf:item concept_id="163183" id="703^POSITIVE^99DCT">
  1134. <xf:label>POSITIVE</xf:label>
  1135. <xf:value>703^POSITIVE^99DCT</xf:value>
  1136. </xf:item>
  1137. </xf:select1>
  1138. <xf:select1 bind="partner_tested">
  1139. <xf:label>Partner tested</xf:label>
  1140. <xf:hint>Partner tested</xf:hint>
  1141. <xf:item concept_id="163182" id="1065^YES^99DCT">
  1142. <xf:label>YES</xf:label>
  1143. <xf:value>1065^YES^99DCT</xf:value>
  1144. </xf:item>
  1145. <xf:item concept_id="163182" id="1066^NO^99DCT">
  1146. <xf:label>NO</xf:label>
  1147. <xf:value>1066^NO^99DCT</xf:value>
  1148. </xf:item>
  1149. </xf:select1>
  1150.  
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  1177.  
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  1188.  
  1189.  
  1190.  
  1191.  
  1192.  
  1193.  
  1194.  
  1195.  
  1196. </xf:group>
  1197. </xf:xforms></Xform><Layout><Form id="67"><Page Text="Page1" fontWeight="normal" fontSize="12px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, Sans-Serif" Binding="Page1" Width="900px" Height="2173px" backgroundColor=""><Item WidgetType="TextBox" HelpText="MEDICAL RECORD NUMBER" Binding="patient/patient.medical_record_number" Left="672px" Top="51px" Width="200px" Height="25px" TabIndex="4" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" Visit Datetime" HelpText="ENCOUNTER DATETIME" Binding="encounter/encounter.encounter_datetime" Left="547px" Top="89px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="DateTimeWidget" Binding="encounter/encounter.encounter_datetime" Left="672px" Top="87px" Width="200px" Height="25px" TabIndex="7" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" Counselling Form" HelpText="Label" Binding="LEFT51pxTOP30px-null" Left="51px" Top="30px" TabIndex="0" fontWeight="bold" fontSize="24px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" NACP Number" HelpText="MEDICAL RECORD NUMBER" Binding="patient/patient.medical_record_number" Left="547px" Top="55px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="GroupBox" Binding="LEFT46pxTOP335px-null" Left="46px" Top="456px" Width="822px" Height="500px" TabIndex="0" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" borderStyle="dashed" borderWidth="1px" borderColor="rgb(26, 172, 155)"><Item WidgetType="Label" Text=" Counselling" HelpText="Header Label" Binding="LEFT46pxTOP335px-null" Left="null" Top="null" Width="100%" Height="20px" TabIndex="0" color="white" fontWeight="bold" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="rgb(26, 172, 155)" textAlign="center" HeaderLabel="true"/><Item WidgetType="RadioButton" Text="1st Session" HelpText="First Session" Binding="162789^First Session^99DCT" ParentBinding="obs/enhanced_adherence_counselling/value" Left="459px" Top="117px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="2nd Session" HelpText="Second Session" Binding="162790^Second Session^99DCT" ParentBinding="obs/enhanced_adherence_counselling/value" Left="598px" Top="119px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="3rd Session" HelpText="Third Session" Binding="162791^Third Session^99DCT" ParentBinding="obs/enhanced_adherence_counselling/value" Left="708px" Top="119px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Done" HelpText="Done" Binding="162787^Done^99DCT" ParentBinding="obs/adherence_counselling/value" Left="459px" Top="156px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Not done" HelpText="Not done" Binding="1118^Not done^99DCT" ParentBinding="obs/adherence_counselling/value" Left="598px" Top="152px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Lay Counselling" HelpText="Lay Counselling" Binding="obs/lay_counselling/value" Left="224px" Top="197px" TabIndex="0" fontWeight="normal" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Done" HelpText="Done" Binding="162787^Done^99DCT" ParentBinding="obs/lay_counselling/value" Left="459px" Top="189px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Not done" HelpText="Not done" Binding="1118^Not done^99DCT" ParentBinding="obs/lay_counselling/value" Left="598px" Top="185px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="PMTCT Counselling" HelpText="PMTCT Counselling" Binding="obs/pmtct_counselling/value" Left="224px" Top="233px" TabIndex="0" fontWeight="normal" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Done" HelpText="Done" Binding="162787^Done^99DCT" ParentBinding="obs/pmtct_counselling/value" Left="459px" Top="229px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Not done" HelpText="Not done" Binding="1118^Not done^99DCT" ParentBinding="obs/pmtct_counselling/value" Left="598px" Top="229px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Disclosure Counselling" HelpText="Disclosure Counselling" Binding="obs/disclosure_counselling/value" Left="224px" Top="269px" TabIndex="0" fontWeight="normal" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Partial Disclosure" HelpText="Partial Disclosure" Binding="162797^Partial Disclosure^99DCT" 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Stigma questionnaire" Binding="obs/total_score_-_stigma_questionnaire/value" Left="208px" Top="75px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" (2 - 35 points)" HelpText="Label" Binding="LEFT519pxTOP72px-null" Left="519px" Top="72px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Total score - Stigma questionnaire" Binding="obs/total_score_-_stigma_questionnaire/value" Left="303px" Top="67px" Width="200px" Height="25px" TabIndex="7" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="HorizontalLine" Binding="LEFT-3pxTOP112px-null" Left="-3px" Top="112px" Width="811px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" borderStyle="solid none none solid" borderWidth="1px"/><Item WidgetType="Label" Text=" Result" HelpText="Label" Binding="LEFT26pxTOP76px-null" Left="26px" Top="76px" TabIndex="0" fontWeight="bold" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" Current" HelpText="Label" Binding="LEFT7pxTOP145px-null" Left="7px" Top="129px" TabIndex="0" fontWeight="bold" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" Notes/Observations" HelpText="Label" Binding="LEFT4pxTOP147px-null" Left="4px" Top="147px" TabIndex="0" fontWeight="bold" fontSize="14px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextArea" HelpText="Stigma Questionnaire - 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Notes" Binding="obs/depression_questionnaire_-_notes/value" Left="212px" Top="121px" Width="288px" Height="75px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/></Item></Item><Item WidgetType="GroupBox" Binding="LEFT45pxTOP971px-null" Left="45px" Top="971px" Width="823px" Height="200px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" borderStyle="dashed" borderWidth="1px" borderColor="rgb(26, 172, 155)"><Item WidgetType="Label" Text=" PrEP" HelpText="Header Label" Binding="LEFT45pxTOP971px-null" Left="-1px" Top="0px" Width="100%" Height="20px" TabIndex="0" color="white" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="rgb(26, 172, 155)" textAlign="center" HeaderLabel="true"/><Item WidgetType="RadioButton" Text=" Yes" HelpText="YES" Binding="1065^YES^99DCT" ParentBinding="obs/partner_tested/value" Left="115px" Top="36px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text=" No" HelpText="NO" Binding="1066^NO^99DCT" ParentBinding="obs/partner_tested/value" Left="175px" Top="36px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Partner tested" HelpText="Partner tested" Binding="obs/partner_tested/value" Left="12px" Top="38px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text=" Negative" HelpText="NEGATIVE" Binding="664^NEGATIVE^99DCT" ParentBinding="obs/partner_result/value" Left="523px" Top="36px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text=" Positive" HelpText="POSITIVE" Binding="703^POSITIVE^99DCT" ParentBinding="obs/partner_result/value" Left="627px" Top="36px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="If Partner is tested Negative, PrEP service" HelpText="If Partner is tested Negative, PrEP service" Binding="obs/if_partner_is_tested_negative_prep_service/value" Left="14px" Top="176px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Started" HelpText="Started" Binding="163186^Started^99DCT" ParentBinding="obs/if_partner_is_tested_negative_prep_service/value" Left="300px" Top="173px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Not started" HelpText="Not started" Binding="163187^Not started^99DCT" ParentBinding="obs/if_partner_is_tested_negative_prep_service/value" Left="398px" Top="173px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="If Positive, does he or she enrolled in KIULARCO?" HelpText="If Positive, does he or she enrolled in KIULARCO?" 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WidgetType="RadioButton" Text=" No" HelpText="NO" Binding="1066^NO^99DCT" ParentBinding="obs/force_abort/value" Left="560px" Top="996px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="If yes, by whom (relationship not a name)" Binding="obs/yes_force_abort/value" Left="553px" Top="1054px" Width="261px" Height="58px" TabIndex="62" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" If yes, by whom (relationship not a name)" HelpText="If yes, by whom (relationship not a name)" Binding="obs/yes_force_abort/value" Left="14px" Top="1061px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text=" No" HelpText="NO" Binding="1066^NO^99DCT" ParentBinding="obs/verbal/value" Left="560px" Top="1133px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" If yes, by whom (relationship not a name)" HelpText="If yes, by whom (relationship not a name)" Binding="obs/yes_verbal/value" Left="17px" Top="1197px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="HorizontalLine" Binding="LEFT-3pxTOP327px-null" Left="-1px" Top="1251px" Width="824px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" borderStyle="solid none none solid" borderWidth="1px"/><Item WidgetType="HorizontalLine" Binding="LEFT-3pxTOP327px-null" Left="-1px" Top="1342px" Width="824px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" borderStyle="solid none none solid" borderWidth="1px"/><Item WidgetType="VerticalLine" Binding="LEFT545pxTOP18px-null" Left="545px" Top="18px" Height="1385px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" borderStyle="solid none none solid" borderWidth="1px"/><Item WidgetType="Label" Text=" Are you afraid of anyone of the people you mention above?" HelpText="Are you afraid of anyone of the people you mention above?" Binding="obs/yes_controlling/value" Left="15px" Top="1357px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" If yes, by whom (relationship not a name)" HelpText="If yes, by whom (relationship not a name)" Binding="obs/yes_physical/value" Left="15px" Top="369px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" In the past 12 months, have you been hit, punched, kicked, slapped, choked, hurt with a weapon, or otherwise physically hurt by someone in your home or outside of your house?" HelpText="In the past 12 months, have you been hit, punched, kicked, slapped, choked, hurt with a weapon, or otherwise physically hurt by someone in your home or outside of your house?" 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HelpText="In the past 12 months, were you forced to have sex to be able to eat, have shelter, or have sex for essential services (such as protection or school) because you or someone in your family would be in physical danger if you refused?" Binding="obs/danger_sex/value" Left="14px" Top="575px" Width="515px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" In the past 12 months, were you physically forced or made to feel that you had to become pregnant against your will?" HelpText="In the past 12 months, were you physically forced or made to feel that you had to become pregnant against your will?" Binding="obs/unwill_preg/value" Left="12px" Top="724px" Width="515px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" In the past 12 months, were you coerced or forced into marriage?" HelpText="In the past 12 months, were you coerced or forced into marriage?" Binding="obs/forced_marriage/value" Left="11px" Top="867px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text=" In the past 12 months, were you coerced or forced to have an abortion?" HelpText="In the past 12 months, were you coerced or forced to have an abortion?" 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value="Done"/><text xpath="xforms/group[@id='1']/select1[@bind='counselling_status']/item[@id='1118^Not done^99DCT']/label" value="Not done"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/label" value="RELATIONSHIPS"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/hint" value="Relationships that this patient has."/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/input[@bind='patient_relative.person']/label" value="RELATIVE"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/label" value="RELATIONSHIP"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='1A']/label" value="is Doctor [1]"/><text xpath="xforms/group[@id='1']/group[@id='patient/patient_relative']/repeat/select1[@bind='patient_relative.relationship']/item[@id='1B']/label" value="is 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@WidgetType='Label'][@Width]" value="515px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/unwill_preg/value' and @WidgetType='Label'][@Text]" value=" In the past 12 months, were you physically forced or made to feel that you had to become pregnant against your will?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/unwill_preg/value' and @WidgetType='Label'][@HelpText]" value="In the past 12 months, were you physically forced or made to feel that you had to become pregnant against your will?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/unwill_preg/value' and @WidgetType='Label'][@Top]" value="724px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/unwill_preg/value' and @WidgetType='Label'][@Left]" value="12px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/unwill_preg/value' and @WidgetType='Label'][@Width]" value="515px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/forced_marriage/value' and @WidgetType='Label'][@Text]" value=" In the past 12 months, were you coerced or forced into marriage?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/forced_marriage/value' and @WidgetType='Label'][@HelpText]" value="In the past 12 months, were you coerced or forced into marriage?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/forced_marriage/value' and @WidgetType='Label'][@Top]" value="867px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/forced_marriage/value' and @WidgetType='Label'][@Left]" value="11px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/force_abort/value' and @WidgetType='Label'][@Text]" value=" In the past 12 months, were you coerced or forced to have an abortion?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/force_abort/value' and @WidgetType='Label'][@HelpText]" value="In the past 12 months, were you coerced or forced to have an abortion?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/force_abort/value' and @WidgetType='Label'][@Top]" value="996px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/force_abort/value' and @WidgetType='Label'][@Left]" value="12px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/verbal/value' and @WidgetType='Label'][@Text]" value=" In the past 12 months, have anyone insulted or humiliated or yelled at you or verbally threated to hurt you or someone you care about?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/verbal/value' and @WidgetType='Label'][@HelpText]" value="In the past 12 months, have anyone insulted or humiliated or yelled at you or verbally threated to hurt you or someone you care about?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/verbal/value' and @WidgetType='Label'][@Top]" value="1133px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/verbal/value' and @WidgetType='Label'][@Left]" value="17px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/verbal/value' and @WidgetType='Label'][@Width]" value="508px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/controlling/value' and @WidgetType='Label'][@Text]" value=" In the past 12 months, has your (current or most recent) husband/partner controlled who to see or talk to, restricted contact with your family and where to go or what to do, forcing you to do anything you do not want to do or controlled your sources of income?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/controlling/value' and @WidgetType='Label'][@HelpText]" 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@ParentBinding='obs/controlling/value' and @WidgetType='RadioButton'][@Text]" value=" No"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1066^NO^99DCT' and @ParentBinding='obs/controlling/value' and @WidgetType='RadioButton'][@HelpText]" value="NO"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1066^NO^99DCT' and @ParentBinding='obs/controlling/value' and @WidgetType='RadioButton'][@Top]" value="1259px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1066^NO^99DCT' and @ParentBinding='obs/controlling/value' and @WidgetType='RadioButton'][@Left]" value="560px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/gbv_screen/value' and @WidgetType='Label'][@Text]" value=" Patient screen for GBV?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/gbv_screen/value' and @WidgetType='Label'][@HelpText]" value="Patient screened for GBV? 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@WidgetType='GroupBox']/Item[@Binding='obs/gbv_any/value' and @WidgetType='Label'][@Top]" value="85px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/gbv_any/value' and @WidgetType='Label'][@Left]" value="16px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/emotional/value' and @WidgetType='Label'][@Text]" value=" In the past 12 months, have you been emotionally or threatened with physical or sexual violence by someone in your home or outside of your home?"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='obs/emotional/value' and @WidgetType='Label'][@HelpText]" value="In the past 12 months, have you been emotionally or threatened with physical or sexual violence by someone in your home or outside of your home?"/><text 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value="157px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/emotional/value' and @WidgetType='RadioButton'][@Left]" value="720px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/physical/value' and @WidgetType='RadioButton'][@Text]" value=" Yes"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/physical/value' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/physical/value' and @WidgetType='RadioButton'][@Top]" value="300px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/physical/value' and @WidgetType='RadioButton'][@Left]" value="720px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/unwill_sex/value' and @WidgetType='RadioButton'][@Text]" value=" Yes"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/unwill_sex/value' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/unwill_sex/value' and @WidgetType='RadioButton'][@Top]" value="438px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/unwill_sex/value' and @WidgetType='RadioButton'][@Left]" value="720px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/danger_sex/value' and @WidgetType='RadioButton'][@Text]" value=" Yes"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/danger_sex/value' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/danger_sex/value' and @WidgetType='RadioButton'][@Top]" value="575px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/danger_sex/value' and @WidgetType='RadioButton'][@Left]" value="720px"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/unwill_preg/value' and @WidgetType='RadioButton'][@Text]" value=" Yes"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/unwill_preg/value' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page2']/Item[@Binding='LEFT36pxTOP58px-null' and @WidgetType='GroupBox']/Item[@Binding='1065^YES^99DCT' and @ParentBinding='obs/unwill_preg/value' and @WidgetType='RadioButton'][@Top]" value="724px"/><text 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