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jerome24

counselling form

jerome24
May 24th, 2024
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  1. <!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
  2. <html xmlns:openmrs="urn:jsptld:/WEB-INF/view/module/legacyui/taglibs/openmrs.tld" xmlns:spring="http://www.springframework.org/tags" xmlns:jsp="http://java.sun.com/JSP/Page" xmlns:c="http://java.sun.com/jsp/jstl/core" xmlns="http://www.w3.org/1999/xhtml"><head>
  3. <meta http-equiv="content-type" content="text/html; charset=UTF-8"><meta http-equiv="X-UA-Compatible" content="IE=8">
  4.  
  5.  
  6.  
  7.  
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  20.  
  21.  
  22.  
  23.  
  24.  
  25.  
  26.  
  27.  
  28.  
  29.  
  30. <script src="OpenMRS%20counselling%20form_files/openmrs.js" type="text/javascript"></script>
  31. <script src="OpenMRS%20counselling%20form_files/openmrsmessages.htm" type="text/javascript"></script>
  32. <link href="OpenMRS%20counselling%20form_files/openmrs.css" type="text/css" rel="stylesheet">
  33. <link href="OpenMRS%20counselling%20form_files/openmrs_green.css" type="text/css" rel="stylesheet">
  34. <link href="OpenMRS%20counselling%20form_files/style.css" type="text/css" rel="stylesheet">
  35. <script src="OpenMRS%20counselling%20form_files/engine_002.js" type="text/javascript"></script>
  36. <script src="OpenMRS%20counselling%20form_files/html-sanitizer-min.js" type="text/javascript"></script>
  37. <script src="OpenMRS%20counselling%20form_files/DWRAlertService.js" type="text/javascript"></script>
  38.  
  39. <script src="OpenMRS%20counselling%20form_files/jquery.min.js" type="text/javascript"></script>
  40. <script src="OpenMRS%20counselling%20form_files/jquery-ui.custom.min.js" type="text/javascript"></script>
  41. <script src="OpenMRS%20counselling%20form_files/jquery-ui-timepicker-addon.js" type="text/javascript"></script>
  42. <script src="OpenMRS%20counselling%20form_files/jquery-ui-datepicker-i18n.js" type="text/javascript"></script>
  43.  
  44.  
  45.  
  46. <script src="OpenMRS%20counselling%20form_files/jquery-ui-timepicker-month-year-patch.js" type="text/javascript"></script>
  47. <link href="OpenMRS%20counselling%20form_files/jquery-ui.custom.css" type="text/css" rel="stylesheet">
  48.  
  49. <link rel="shortcut icon" type="image/ico" href="http://192.168.6.7:8080/openmrs/images/openmrs-favicon.ico">
  50. <link rel="icon" type="image/png" href="http://192.168.6.7:8080/openmrs/images/openmrs-favicon.png">
  51.  
  52.  
  53.  
  54.  
  55. <title>OpenMRS</title>
  56.  
  57.  
  58.  
  59.  
  60. <script type="text/javascript">
  61.  
  62. var $j = jQuery.noConflict();
  63.  
  64. /* variable used in js to know the context path */
  65. var openmrsContextPath = '/openmrs';
  66. var dwrLoadingMessage = 'Loading...';
  67. var jsDateFormat = 'mm/dd/yyyy';
  68. var jsTimeFormat = 'hh:mm TT';
  69. var jsLocale = 'en';
  70.  
  71. /* prevents users getting false dwr errors msgs when leaving pages */
  72. var pageIsExiting = false;
  73. if (typeof(jQuery) != "undefined")
  74. jQuery(window).bind('beforeunload', function () { pageIsExiting = true; } );
  75.  
  76. var handler = function(msg, ex) {
  77. if (!pageIsExiting) {
  78. var div = document.getElementById("openmrs_dwr_error");
  79. div.style.display = ""; // show the error div
  80. var msgDiv = document.getElementById("openmrs_dwr_error_msg");
  81. msgDiv.innerHTML = 'A javascript error has occurred:' + " <b>" + msg + "</b>";
  82. }
  83.  
  84. };
  85. dwr.engine.setErrorHandler(handler);
  86. dwr.engine.setWarningHandler(handler);
  87.  
  88. /* initialize common form validation */
  89.  
  90. jQuery(document).ready(initializeForceMaxLength);
  91.  
  92. </script>
  93.  
  94.  
  95.  
  96. <link rel="stylesheet" href="OpenMRS%20counselling%20form_files/standard.css"><link rel="stylesheet" href="OpenMRS%20counselling%20form_files/DatePickerStyle.css"><link rel="stylesheet" href="OpenMRS%20counselling%20form_files/FormRunner.css"></head>
  97.  
  98. <body>
  99. <div id="pageBody">
  100.  
  101. <div id="userBar">
  102.  
  103.  
  104. <span id="userLoggedInAs" class="firstChild">
  105. Currently logged in as Jerome Lwali
  106. </span>
  107. <span id="userLogout">
  108. <a href="http://192.168.6.7:8080/openmrs/ms/logout">Log out</a>
  109. </span>
  110. <span>
  111. <a href="http://192.168.6.7:8080/openmrs/options.form">My Profile</a>
  112. </span>
  113.  
  114.  
  115.  
  116.  
  117. <span id="userHelp">
  118. <a href="http://192.168.6.7:8080/openmrs/help.htm">Help</a>
  119. </span>
  120.  
  121. </div>
  122.  
  123. <div id="banner" xmlns:c="http://java.sun.com/jsp/jstl/core" xmlns:jsp="http://java.sun.com/JSP/Page" xmlns:spring="http://www.springframework.org/tags" xmlns:openmrs="urn:jsptld:/WEB-INF/view/module/legacyui/taglibs/openmrs.tld">
  124. <a href="http://192.168.6.7:8080/openmrs/index.htm">
  125. <div id="logosmall"><img src="OpenMRS%20counselling%20form_files/openmrs_logo_text_small.png" alt="OpenMRS Logo" border="0"></div>
  126. </a>
  127. <table id="bannerbar">
  128. <tbody><tr>
  129. <td id="logocell"> <img src="OpenMRS%20counselling%20form_files/openmrs_logo_white.gif" alt="" class="logo-reduced61">
  130. </td>
  131. <td id="barcell">
  132. <div class="barsmall" id="barsmall">
  133. <img align="left" src="OpenMRS%20counselling%20form_files/openmrs_green_bar.gif" alt="" class="bar-round-reduced50" id="bar-round-reduced50" style="height: 27px;">
  134.  
  135. <ul class="navList" xmlns:spring="http://www.springframework.org/tags" xmlns:openmrs="urn:jsptld:/WEB-INF/view/module/legacyui/taglibs/openmrs.tld">
  136.  
  137. <li id="homeNavLink" class="firstChild">
  138. <a href="http://192.168.6.7:8080/openmrs/">Home</a>
  139. </li>
  140.  
  141.  
  142. <li id="findPatientNavLink">
  143. <a href="http://192.168.6.7:8080/openmrs/findPatient.htm">
  144.  
  145. Find/Create Patient
  146.  
  147.  
  148. </a>
  149. </li>
  150.  
  151.  
  152.  
  153. <li id="dictionaryNavLink">
  154. <a href="http://192.168.6.7:8080/openmrs/dictionary/index.htm">Dictionary</a>
  155. </li>
  156.  
  157.  
  158.  
  159.  
  160. <li>
  161. <a href="http://192.168.6.7:8080/openmrs/cohortBuilder.list">Cohort Builder</a>
  162. </li>
  163.  
  164.  
  165.  
  166. <li>
  167. <a href="http://192.168.6.7:8080/openmrs/module/reporting/dashboard/index.form">Reporting</a>
  168. </li>
  169.  
  170.  
  171.  
  172. <li>
  173. <a href="http://192.168.6.7:8080/openmrs/module/appointmentscheduling/appointmentList.list">Appointments</a>
  174. </li>
  175.  
  176.  
  177.  
  178.  
  179. <li id="administrationNavLink">
  180. <a href="http://192.168.6.7:8080/openmrs/admin/index.htm">Administration</a>
  181. </li>
  182.  
  183.  
  184.  
  185. </ul>
  186.  
  187.  
  188. </div>
  189. <script type="text/javascript">
  190. function resize(){
  191. document.getElementById('bar-round-reduced50').style.height = document.getElementById('barsmall').offsetHeight+"px";
  192. }
  193. window.onload=resize;
  194. window.onresize=resize;
  195. </script>
  196.  
  197. </td>
  198. </tr>
  199. </tbody></table>
  200. </div>
  201.  
  202.  
  203.  
  204.  
  205. <div id="content">
  206.  
  207.  
  208.  
  209.  
  210.  
  211.  
  212. <div id="openmrs_dwr_error" style="display:none" class="error">
  213. <div id="openmrs_dwr_error_msg"></div>
  214. <div id="openmrs_dwr_error_close" class="smallMessage">
  215. <i>The full stacktrace for this error can usually be found in your server's error logs.</i>
  216. <a href="#" onclick="this.parentNode.parentNode.style.display='none'">Hide error</a>
  217. </div>
  218. </div>
  219.  
  220.  
  221.  
  222.  
  223.  
  224.  
  225. <script type="text/javascript" src="OpenMRS%20counselling%20form_files/engine.js"></script>
  226. <script type="text/javascript" src="OpenMRS%20counselling%20form_files/util.js"></script>
  227. <script type="text/javascript" src="OpenMRS%20counselling%20form_files/DWRXformsService.js"></script>
  228.  
  229. <script src="OpenMRS%20counselling%20form_files/calendar.js" type="text/javascript"></script>
  230. <script src="OpenMRS%20counselling%20form_files/timepicker.js" type="text/javascript"></script>
  231.  
  232.  
  233. <script src="OpenMRS%20counselling%20form_files/DWRConceptService.js" type="text/javascript"></script>
  234. <script src="OpenMRS%20counselling%20form_files/DWRPersonService.js" type="text/javascript"></script>
  235. <script src="OpenMRS%20counselling%20form_files/DWRProviderService.js" type="text/javascript"></script>
  236. <script src="OpenMRS%20counselling%20form_files/OpenmrsAutoComplete.js" type="text/javascript"></script>
  237. <script src="OpenMRS%20counselling%20form_files/jquery.ui.autocomplete.autoSelect.js" type="text/javascript"></script>
  238.  
  239.  
  240. <style type="text/css">
  241. body {
  242. font-size: 12px;
  243. }
  244.  
  245. .popupSearchForm {
  246. width: 500px;
  247. height: 390px;
  248. padding: 2px;
  249. background-color: whitesmoke;
  250. border: 1px solid gray;
  251. position: absolute;
  252. display: block;
  253. z-index: 10;
  254. margin: 5px;
  255. overflow-y: auto;
  256. }
  257.  
  258. .smallButton {
  259. font-size: .7em;
  260. border: 0px solid lightgrey;
  261. cursor: pointer;
  262. width: 0px;
  263. height: 0px;
  264. margin: 0px;
  265. }
  266.  
  267. .description {
  268. font-size: .9em;
  269. padding-left: 10px;
  270. color: gray;
  271. }
  272.  
  273. .closeButton {
  274. border: 1px solid gray;
  275. background-color: lightpink;
  276. font-size: .6em;
  277. color: black;
  278. float: right;
  279. margin: 2px;
  280. padding: 1px;
  281. cursor: pointer;
  282. }
  283.  
  284. #proposeConceptForm { display: none; }
  285. .alert { color: red; }
  286.  
  287. </style>
  288.  
  289. <script type="text/javascript">
  290. var djConfig = {debugAtAllCosts: false, isDebug: false };
  291. </script>
  292.  
  293. <script src="OpenMRS%20counselling%20form_files/FormRunner.nocache.js" type="text/javascript"></script><script defer="defer">FormRunner.onInjectionDone('FormRunner')</script>
  294.  
  295. <iframe src="javascript:''" id="__gwt_historyFrame" tabindex="-1" style="position:absolute;width:0;height:0;border:0"></iframe>
  296.  
  297. <div id="purcformrunner"><table cellspacing="0" cellpadding="0" style="width: 100%; height: 100%;"><tbody><tr><td align="left" style="vertical-align: top;" width="" height=""><table cellspacing="0" cellpadding="0" class="gwt-DecoratedTabPanel" style="width: 100%; height: 100%;"><tbody><tr><td align="left" style="vertical-align: top;"><table cellspacing="0" cellpadding="0" class="gwt-DecoratedTabBar" role="tablist" style="width: 100%; font-weight: normal; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><tbody><tr><td align="left" style="vertical-align: bottom;" height="100%" class="gwt-TabBarFirst-wrapper"><div class="gwt-TabBarFirst" style="white-space: normal; height: 100%;">&nbsp;</div></td><td align="left" style="vertical-align: bottom;" class="gwt-TabBarItem-wrapper"><table cellspacing="0" cellpadding="0" class="gwt-TabBarItem"><tbody><tr class="tabTop"><td class="tabTopLeft"><div class="tabTopLeftInner"></div></td><td class="tabTopCenter"><div class="tabTopCenterInner"></div></td><td class="tabTopRight"><div class="tabTopRightInner"></div></td></tr><tr class="tabMiddle"><td class="tabMiddleLeft"><div class="tabMiddleLeftInner"></div></td><td class="tabMiddleCenter"><div class="tabMiddleCenterInner"><div tabindex="0" role="tab"><input type="text" tabindex="-1" style="opacity: 0; height: 1px; width: 1px; z-index: -1; overflow: hidden; position: absolute;"><div class="gwt-HTML" style="white-space: nowrap;"><span class="gwt-HTML" style="white-space: nowrap; font-weight: normal; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Page1</span></div></div></div></td><td class="tabMiddleRight"><div class="tabMiddleRightInner"></div></td></tr></tbody></table></td><td align="left" style="vertical-align: bottom;" class="gwt-TabBarItem-wrapper gwt-TabBarItem-wrapper-selected"><table cellspacing="0" cellpadding="0" class="gwt-TabBarItem gwt-TabBarItem-selected"><tbody><tr class="tabTop"><td class="tabTopLeft"><div class="tabTopLeftInner"></div></td><td class="tabTopCenter"><div class="tabTopCenterInner"></div></td><td class="tabTopRight"><div class="tabTopRightInner"></div></td></tr><tr class="tabMiddle"><td class="tabMiddleLeft"><div class="tabMiddleLeftInner"></div></td><td class="tabMiddleCenter"><div class="tabMiddleCenterInner"><div tabindex="0" role="tab"><input type="text" tabindex="-1" style="opacity: 0; height: 1px; width: 1px; z-index: -1; overflow: hidden; position: absolute;"><div class="gwt-HTML" style="white-space: nowrap;"><span class="gwt-HTML" style="white-space: nowrap; font-weight: normal; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Page2</span></div></div></div></td><td class="tabMiddleRight"><div class="tabMiddleRightInner"></div></td></tr></tbody></table></td><td align="left" style="vertical-align: bottom;" width="100%" class="gwt-TabBarRest-wrapper"><div class="gwt-TabBarRest" style="white-space: normal; height: 100%;">&nbsp;</div></td></tr></tbody></table></td></tr><tr><td align="left" style="vertical-align: top;" height="100%"><div class="gwt-TabPanelBottom" role="tabpanel" style="border-color: rgb(26, 172, 155);"><div style="width: 100%; height: 100%; padding: 0px; margin: 0px; display: none;"><div style="position: relative; overflow: hidden; width: 900px; height: 2173px; display: none;" class="gwt-purcforms"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="position: absolute; left: 547px; top: 89px;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="ENCOUNTER DATETIME" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Visit Datetime</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="position: absolute; left: 51px; top: 30px;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 24px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Counselling Form</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="position: absolute; left: 547px; top: 55px;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="MEDICAL RECORD NUMBER" style="opacity: 0.6; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> NACP Number</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 822px; position: absolute; left: 46px; top: 456px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 822px; height: 500px; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 117px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="First Session" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/enhanced_adherence_counselling/value" id="gwt-uid-1" tabindex="0" disabled="disabled"><label for="gwt-uid-1">1st Session</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 119px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Second Session" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/enhanced_adherence_counselling/value" id="gwt-uid-2" tabindex="0" disabled="disabled"><label for="gwt-uid-2">2nd Session</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 708px; top: 119px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Third Session" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/enhanced_adherence_counselling/value" id="gwt-uid-3" tabindex="0" disabled="disabled"><label for="gwt-uid-3">3rd Session</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 156px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/adherence_counselling/value" id="gwt-uid-4" tabindex="0" disabled="disabled"><label for="gwt-uid-4">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 152px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/adherence_counselling/value" id="gwt-uid-5" tabindex="0" disabled="disabled"><label for="gwt-uid-5">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 197px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Lay Counselling" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Lay Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 189px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/lay_counselling/value" id="gwt-uid-6" tabindex="0" disabled="disabled"><label for="gwt-uid-6">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 185px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/lay_counselling/value" id="gwt-uid-7" tabindex="0" disabled="disabled"><label for="gwt-uid-7">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 233px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="PMTCT Counselling" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">PMTCT Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 229px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/pmtct_counselling/value" id="gwt-uid-8" tabindex="0" disabled="disabled"><label for="gwt-uid-8">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 229px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/pmtct_counselling/value" id="gwt-uid-9" tabindex="0" disabled="disabled"><label for="gwt-uid-9">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 269px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Disclosure Counselling" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Disclosure Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 265px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Partial Disclosure" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/disclosure_counselling/value" id="gwt-uid-10" tabindex="0" disabled="disabled"><label for="gwt-uid-10">Partial Disclosure</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 271px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Full Disclosure" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/disclosure_counselling/value" id="gwt-uid-11" tabindex="0" disabled="disabled"><label for="gwt-uid-11">Full Disclosure</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 197px; top: 51px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-vertical-grid-line" style="border-style: solid none none solid; border-width: 1px; height: 447px; line-height: 447px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 308px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="PrEP Counselling" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">PrEP Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 308px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/prep_counselling/value" id="gwt-uid-12" tabindex="0" disabled="disabled"><label for="gwt-uid-12">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 302px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/prep_counselling/value" id="gwt-uid-13" tabindex="0" disabled="disabled"><label for="gwt-uid-13">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 346px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Other Counselling Purpose" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Other Counselling Purpose</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 346px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/other_counselling_purpose/value" id="gwt-uid-14" tabindex="0" disabled="disabled"><label for="gwt-uid-14">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 342px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/other_counselling_purpose/value" id="gwt-uid-15" tabindex="0" disabled="disabled"><label for="gwt-uid-15">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 377px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Specify other counsellings" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">If other, Specify</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 821px; left: 2px; top: 417px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 821px; height: 0px; line-height: 0px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 187px; top: 22px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/counselling_status/value" id="gwt-uid-16" tabindex="0" checked="checked"><label for="gwt-uid-16">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 79px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Counselling before starting ART" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Pre-ART Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 160px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Adherence Counselling" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Adherence Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 0px; top: 148px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="What counselling has been done today?" style="height: 34px; line-height: 34px; font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: left;"> What counselling has</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 4px; top: 183px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> been done today?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 224px; top: 117px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Enhanced Adherence Counselling" style="font-weight: normal; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Enhanced Adherence Counselling</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 708px; top: 81px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Third Session" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/pre-art_counselling/value" id="gwt-uid-17" tabindex="0" disabled="disabled"><label for="gwt-uid-17">3rd Session</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 598px; top: 79px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Second Session" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/pre-art_counselling/value" id="gwt-uid-18" tabindex="0" disabled="disabled"><label for="gwt-uid-18"> 2nd Session</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 459px; top: 77px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="First Session" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/pre-art_counselling/value" id="gwt-uid-19" tabindex="0" disabled="disabled"><label for="gwt-uid-19"> 1st Session</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 3px; top: 455px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Notes/Observations</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 2px; top: 434px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Current</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 288px; left: 207px; top: 424px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><textarea class="gwt-TextArea" tabindex="0" title="Notes/Observations taken in the Counselling section" style="width: 288px; height: 60px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/counselling_notes/value"></textarea></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 827px; left: -1px; top: 51px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 827px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 98px; top: 24px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/counselling_status/value" id="gwt-uid-20" tabindex="0"><label for="gwt-uid-20">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 409px; top: 377px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="32" title="Specify other counsellings" style="width: 200px; height: 25px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/others_-_counselling_section/value" disabled="disabled"></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 822px; position: absolute; left: 46px; top: 129px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 822px; height: 172px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> Demographics</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 588px; top: 32px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="FAMILY NAME" style="opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Last Name</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 24px; top: 32px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="GIVEN NAME" style="opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> First Name</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 313px; top: 37px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="MIDDLE NAME" style="height: 0px; line-height: 0px; opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Middle Name</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 26px; top: 104px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="BIRTHDATE" style="opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Date of Birth</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 313px; top: 104px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="SEX" style="opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Sex</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 22px; top: 126px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="1" title="BIRTHDATE" style="width: 200px; height: 25px; opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="patient/patient.birthdate" value="07/08/1984"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 591px; top: 57px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="2" title="FAMILY NAME" style="width: 200px; height: 25px; opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="patient/patient.family_name" value="Patient"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 24px; top: 57px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="3" title="GIVEN NAME" style="width: 200px; height: 25px; opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="patient/patient.given_name" value="New"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 313px; top: 57px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="5" title="MIDDLE NAME" style="width: 200px; height: 25px; opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="patient/patient.middle_name" value="Test"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 313px; top: 126px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="6" title="SEX" style="width: 200px; height: 25px; opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="patient/patient.sex" value="F"></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 823px; position: absolute; left: 45px; top: 315px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 823px; height: 124px; font-weight: normal; font-style: normal; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> Visitect</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 658px; top: 33px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="YES" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/visitect/value" id="gwt-uid-21" tabindex="0"><label for="gwt-uid-21"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 827px; left: -2px; top: 68px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 827px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 693px; top: 83px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Invalid result" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/visitect_res/value" id="gwt-uid-22" tabindex="0" disabled="disabled"><label for="gwt-uid-22">Invalid result</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 472px; top: 83px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="&gt; 200 CD4 T cells/microL" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/visitect_res/value" id="gwt-uid-23" tabindex="0" disabled="disabled"><label for="gwt-uid-23">&gt; 200 CD4 T cells/microL</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 261px; top: 84px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="&lt;= 200 CD4 T cells/microL" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/visitect_res/value" id="gwt-uid-24" tabindex="0" disabled="disabled"><label for="gwt-uid-24">&lt;= 200 CD4 T cells/microL</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 471px; top: 34px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="NO" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/visitect/value" id="gwt-uid-25" tabindex="0" checked="checked"><label for="gwt-uid-25"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 19px; top: 37px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Was Visitect (Rapid CD4) done today?" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Was Visitect (Rapid CD4) done today?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 22px; top: 86px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Visitect (Rapid CD4) results" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Visitect (Rapid CD4) results</div></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="position: absolute; left: 45px; top: 2094px;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 20px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Go to the top of the page, and click page 2</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 822px; position: absolute; left: 40px; top: 1828px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 822px; height: 243px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);">Group Therapy</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 825px; left: 1px; top: 60px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 825px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 826px; left: 1px; top: 132px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 826px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 207px; top: 58px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-vertical-grid-line" style="border-style: solid none none solid; border-width: 1px; height: 200px; line-height: 200px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 98px; top: 26px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/group_therapy_status/value" id="gwt-uid-26" tabindex="0"><label for="gwt-uid-26">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 187px; top: 26px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/group_therapy_status/value" id="gwt-uid-27" tabindex="0" checked="checked"><label for="gwt-uid-27">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 5px; top: 74px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Number of sessions at 6-12 months" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If done, number of</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 0px; top: 96px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> sessions at 6-12 months</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 6px; top: 168px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Group Therapy - Notes" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Current</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 5px; top: 188px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Notes/Observations</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 274px; left: 229px; top: 144px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><textarea class="gwt-TextArea" tabindex="0" title="Group Therapy - Notes" style="width: 274px; height: 84px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/group_therapy_-_notes/value" disabled="disabled"></textarea></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 231px; top: 82px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="7" title="Number of sessions at 6-12 months" style="width: 200px; height: 25px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/number_of_sessions_-_group_therapy/value" disabled="disabled"></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 822px; position: absolute; left: 42px; top: 1676px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 822px; height: 137px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> Stigma Video</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 827px; left: -2px; top: 59px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 827px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 207px; top: 59px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-vertical-grid-line" style="border-style: solid none none solid; border-width: 1px; height: 72px; line-height: 72px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 98px; top: 26px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/stigma_video_status/value" id="gwt-uid-28" tabindex="0"><label for="gwt-uid-28"> Shown</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 187px; top: 26px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/stigma_video_status/value" id="gwt-uid-29" tabindex="0" checked="checked"><label for="gwt-uid-29"> Not Shown</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 15px; top: 73px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Current</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 8px; top: 91px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Notes/Observations</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 279px; left: 228px; top: 67px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><textarea class="gwt-TextArea" tabindex="0" title="Stigma Video - Notes" style="width: 279px; height: 60px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/stigma_video_-_notes/value" disabled="disabled"></textarea></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 822px; position: absolute; left: 44px; top: 1192px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 822px; height: 467px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);">Questionnaires</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 98px; top: 20px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/questionnaires_status/value" id="gwt-uid-30" tabindex="0"><label for="gwt-uid-30">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 187px; top: 17px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/questionnaires_status/value" id="gwt-uid-31" tabindex="0" checked="checked"><label for="gwt-uid-31">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 811px; left: 5px; top: 46px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 811px; height: 190px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; left: -2px; top: -2px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> Stigma Questionnaire(Berger 2001 adapted)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 808px; left: -3px; top: 52px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 808px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 199px; top: 51px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-vertical-grid-line" style="border-style: solid none none solid; border-width: 1px; height: 200px; line-height: 200px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 187px; top: 20px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/stigma_questionnaires_status/value" id="gwt-uid-32" tabindex="0" disabled="disabled"><label for="gwt-uid-32">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 98px; top: 20px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/stigma_questionnaires_status/value" id="gwt-uid-33" tabindex="0" disabled="disabled"><label for="gwt-uid-33">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 208px; top: 75px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Total score - Stigma questionnaire" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Total Score</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 519px; top: 72px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> (2 - 35 points)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 811px; left: -3px; top: 112px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 811px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 26px; top: 76px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Result</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 7px; top: 129px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Current</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 4px; top: 147px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Notes/Observations</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 288px; left: 210px; top: 122px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><textarea class="gwt-TextArea" tabindex="0" title="Stigma Questionnaire - Notes" style="width: 288px; height: 57px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/stigma_questionnaire_-_notes/value" disabled="disabled"></textarea></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 303px; top: 67px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="7" title="Total score - Stigma questionnaire" style="width: 200px; height: 25px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/total_score_-_stigma_questionnaire/value" disabled="disabled"></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 808px; left: 7px; top: 249px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 808px; height: 206px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; left: -2px; top: -2px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> Depression Questionnaire (PHQ-9)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 809px; left: -3px; top: 55px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 809px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 806px; left: -1px; top: 111px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 806px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 98px; top: 25px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/depression_questionnaires_status/value" id="gwt-uid-34" tabindex="0" disabled="disabled"><label for="gwt-uid-34">Done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 200px; top: 57px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-vertical-grid-line" style="border-style: solid none none solid; border-width: 1px; height: 200px; line-height: 200px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 212px; top: 76px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Total score - Depression" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Total Score</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 527px; top: 80px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> (0 - 27 points)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 187px; top: 25px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not done" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/depression_questionnaires_status/value" id="gwt-uid-35" tabindex="0" disabled="disabled"><label for="gwt-uid-35">Not done</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 25px; top: 77px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Result</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 2px; top: 152px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Notes/Observations</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 6px; top: 132px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Label" style="font-weight: bold; font-size: 14px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Current</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 288px; left: 212px; top: 121px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><textarea class="gwt-TextArea" tabindex="0" title="Depression Questionnaire - Notes" style="width: 288px; height: 75px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/depression_questionnaire_-_notes/value" disabled="disabled"></textarea></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 314px; top: 76px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="8" title="Total score - Depression" style="width: 200px; height: 25px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/depression_score/value" disabled="disabled"></td></tr></tbody></table></div></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 823px; position: absolute; left: 45px; top: 971px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 823px; height: 200px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; left: -1px; top: 0px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> PrEP</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 115px; top: 36px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="YES" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/partner_tested/value" id="gwt-uid-36" tabindex="0"><label for="gwt-uid-36"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 175px; top: 36px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="NO" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/partner_tested/value" id="gwt-uid-37" tabindex="0" checked="checked"><label for="gwt-uid-37"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 12px; top: 38px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Partner tested" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Partner tested</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 523px; top: 36px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NEGATIVE" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/partner_result/value" id="gwt-uid-38" tabindex="0" disabled="disabled"><label for="gwt-uid-38"> Negative</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 627px; top: 36px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="POSITIVE" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/partner_result/value" id="gwt-uid-39" tabindex="0" disabled="disabled"><label for="gwt-uid-39"> Positive</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 14px; top: 176px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If Partner is tested Negative, PrEP service" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">If Partner is tested Negative, PrEP service</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 300px; top: 173px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Started" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/if_partner_is_tested_negative_prep_service/value" id="gwt-uid-40" tabindex="0" disabled="disabled"><label for="gwt-uid-40">Started</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 398px; top: 173px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="Not started" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/if_partner_is_tested_negative_prep_service/value" id="gwt-uid-41" tabindex="0" disabled="disabled"><label for="gwt-uid-41">Not started</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 15px; top: 86px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If Positive, does he or she enrolled in KIULARCO?" style="height: 5px; line-height: 5px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">If Positive, does he or she enrolled in KIULARCO?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 463px; top: 72px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/if_positive_does_he_or_she_enrolled_in_kiularco/value" id="gwt-uid-42" tabindex="0" disabled="disabled"><label for="gwt-uid-42"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 392px; top: 72px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/if_positive_does_he_or_she_enrolled_in_kiularco/value" id="gwt-uid-43" tabindex="0" disabled="disabled"><label for="gwt-uid-43"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 820px; left: 1px; top: 109px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 820px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 7px; top: 126px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If Yes, enter the NACP number" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">If Yes, enter the NACP number</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 820px; left: 1px; top: 156px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 820px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 820px; left: 1px; top: 64px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 820px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 394px; top: 43px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Partner result" style="height: 7px; line-height: 7px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;">Partner result</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; left: 244px; top: 122px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="12" title="If Yes, enter the NACP number" style="width: 200px; height: 25px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/if_yes_enter_the_nacp_number/value" disabled="disabled"></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; position: absolute; left: 672px; top: 51px;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="4" title="MEDICAL RECORD NUMBER" style="width: 200px; height: 25px; opacity: 0.6; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="patient/patient.medical_record_number" value="05050100112233"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; position: absolute; left: 672px; top: 87px;"><tbody><tr><td align="left" style="vertical-align: top;"><table cellspacing="0" cellpadding="0" style="width: 200px; height: 25px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><tbody><tr><td align="left" style="vertical-align: top;" width="52%"><input type="text" class="gwt-TextBox" style="width: 100%; height: 100%; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" tabindex="7" value="24/05/2024"></td><td align="left" style="vertical-align: top;" width="48%"><input type="text" class="gwt-TextBox" maxlength="8" style="width: 100%; height: 100%; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" tabindex="7" value="12:22 PM"></td></tr></tbody></table></td></tr></tbody></table></div></div><div style="width: 100%; height: 100%; padding: 0px; margin: 0px;"><div style="position: relative; overflow: hidden; width: 900px; height: 1600px;" class="gwt-purcforms"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="position: absolute; left: 49px; top: 1483px;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="PROVIDER ID" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Provider Name</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 200px; position: absolute; left: 179px; top: 1481px;"><tbody><tr><td align="left" style="vertical-align: top;"><select class="gwt-ListBox" tabindex="0" title="PROVIDER ID" style="width: 200px; height: 25px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><option value=""></option><option value="1">Claudio Zaugg [12]</option><option value="2">Lucas Gervas Shayo [13]</option><option value="4">Agata Correia Agata [3]</option><option value="5">Maja Weisser</option><option value="6">Herry Robert Mapesi</option><option value="7">George Rocky Sikalengo</option><option value="8">ANDREW KATENDE</option><option value="9">Robert Christopher Ndege</option><option value="10">Getrud Joseph Mollel</option><option value="11">Ezekiel Luoga</option><option value="12">Lilian Moshi</option><option value="13">Vanesa Anton Vazquez</option><option value="14">Rahel Bircher</option><option value="15">Gidion Fue</option><option value="16">Athuman Mtandanguo</option><option value="17">Specioza Hwaya</option><option value="18">Armon Arpagaus</option><option value="19">Sambuta Aloyce [125-5]</option><option value="20">Anna Eichenberger [129-7]</option><option value="21">Felister Godson Kiwelu</option><option value="22">Phamarcy CDCI [132-1]</option><option value="23">Pharmacy one Stop [133-9]</option><option value="24">Linn Jarte</option><option value="25">Omary Ngome Rajab [137-0]</option><option value="26">Laura Gimenez Letona [139-6]</option><option value="27">Herieth wilson ismael [140-4]</option><option value="28">Selerine John Myeya [60-4]</option><option value="29">PHILIP SCHMASSMANN [141-2]</option><option value="30">Elizabeth Eliet Senkoro [142-0]</option><option value="31">Vera Hodel [143-8]</option><option value="32">Joshua Joseph Kapungu [144-6]</option><option value="33">Andre Hofer [146-1]</option><option value="35">James Okuma [148-7]</option><option value="36">Sandra Glauser [149-5]</option><option value="37">Raphael Magnolini [151-1]</option><option value="38">Olivia John Kitau [152-9]</option><option value="39">Alois Mbuta [153-7]</option><option value="40">Paul Camille Genton [154-5]</option><option value="41">Evarist Chiweka [19-0]</option><option value="42">John Malugu [44-8]</option><option value="43">Ivana Di Salvo [157-8]</option><option value="44">Michael Charles Kasmiri [159-4]</option><option value="45">George Frederick Mkoma [95-0]</option><option value="46">Mary Gregory Marandu [107-3]</option><option value="47">Asha Juma Haroub [13-3]</option><option value="48">Bernard Gabriel Kivuma [75-2]</option><option value="49">Jacopo Nicoletti [158-6]</option><option value="50">Slyakus Vintan Mlembe [145-3]</option><option value="51">George Frederick Sigalla [164-4]</option><option value="52">Francisca Seraphin Chuwa [165-1]</option><option value="53">Farida Bani [114-9]</option><option value="54">Yvonne Ramesh Haridas [171-9]</option><option value="55">Jacqueline Inoja Nkouabi [170-1]</option><option value="56">Suzan Ngalimecha Ngahyoma [172-7]</option><option value="57">Regina Ndaki [84-4]</option><option value="58">Sarah Katharina Staehelin [175-0]</option><option value="59">John Wigayi [61-2]</option><option value="60">Mabula John [59-6]</option><option value="61">Athuman Said Mtandanguo [64-6]</option><option value="62">Mohamed Godfrey Mbaruku [173-5]</option><option value="63">Juma Kupewa [176-8]</option><option value="64">Leila Samson [85-1]</option><option value="65">Ramadhan Katala [177-6]</option><option value="67">Lulu Wilson Ismael [180-0]</option><option value="68">Rabson Namtwanga [181-8]</option><option value="69">Belina Byabato [182-6]</option><option value="70">Sturida Patrick [183-4]</option><option value="71">Florent Raphael Heritier [184-2]</option><option value="72">Happyphania Isaya Ngakongwa [167-7]</option><option value="73">Petro Togolani Sabuni [185-9]</option><option value="74">Cecilia Philipo Ligogo [186-7]</option><option value="75">Selerine Myeya [46-3]</option><option value="76">Namsifueli Julius Ley [187-5]</option><option value="77">Bedran Topyurek [188-3]</option><option value="78">Edgar Enzigard Martin [189-1]</option><option value="79">Fredy Geiger [190-9]</option><option value="3">Herry Robert Mapesi [14]</option><option value="1">Claudio Zaugg [12]</option><option value="2">Lucas Gervas Shayo [13]</option><option value="4">Agata Correia Agata [3]</option><option value="5">Maja Weisser</option><option value="6">Herry Robert Mapesi</option><option value="7">George Rocky Sikalengo</option><option value="8">ANDREW KATENDE</option><option value="9">Robert Christopher Ndege</option><option value="10">Getrud Joseph Mollel</option><option value="11">Ezekiel Luoga</option><option value="12">Lilian Moshi</option><option value="13">Vanesa Anton Vazquez</option><option value="14">Rahel Bircher</option><option value="15">Gidion Fue</option><option value="16">Athuman Mtandanguo</option><option value="17">Specioza Hwaya</option><option value="18">Armon Arpagaus</option><option value="19">Sambuta Aloyce [125-5]</option><option value="20">Anna Eichenberger [129-7]</option><option value="21">Felister Godson Kiwelu</option><option value="22">Phamarcy CDCI [132-1]</option><option value="23">Pharmacy one Stop [133-9]</option><option value="24">Linn Jarte</option><option value="25">Omary Ngome Rajab [137-0]</option><option value="26">Laura Gimenez Letona [139-6]</option><option value="27">Herieth wilson ismael [140-4]</option><option value="28">Selerine John Myeya [60-4]</option><option value="29">PHILIP SCHMASSMANN [141-2]</option><option value="30">Elizabeth Eliet Senkoro [142-0]</option><option value="31">Vera Hodel [143-8]</option><option value="32">Joshua Joseph Kapungu [144-6]</option><option value="33">Andre Hofer [146-1]</option><option value="35">James Okuma [148-7]</option><option value="36">Sandra Glauser [149-5]</option><option value="37">Raphael Magnolini [151-1]</option><option value="38">Olivia John Kitau [152-9]</option><option value="39">Alois Mbuta [153-7]</option><option value="40">Paul Camille Genton [154-5]</option><option value="41">Evarist Chiweka [19-0]</option><option value="42">John Malugu [44-8]</option><option value="43">Ivana Di Salvo [157-8]</option><option value="44">Michael Charles Kasmiri [159-4]</option><option value="45">George Frederick Mkoma [95-0]</option><option value="46">Mary Gregory Marandu [107-3]</option><option value="47">Asha Juma Haroub [13-3]</option><option value="48">Bernard Gabriel Kivuma [75-2]</option><option value="49">Jacopo Nicoletti [158-6]</option><option value="50">Slyakus Vintan Mlembe [145-3]</option><option value="51">George Frederick Sigalla [164-4]</option><option value="52">Francisca Seraphin Chuwa [165-1]</option><option value="53">Farida Bani [114-9]</option><option value="54">Yvonne Ramesh Haridas [171-9]</option><option value="55">Jacqueline Inoja Nkouabi [170-1]</option><option value="56">Suzan Ngalimecha Ngahyoma [172-7]</option><option value="57">Regina Ndaki [84-4]</option><option value="58">Sarah Katharina Staehelin [175-0]</option><option value="59">John Wigayi [61-2]</option><option value="60">Mabula John [59-6]</option><option value="61">Athuman Said Mtandanguo [64-6]</option><option value="62">Mohamed Godfrey Mbaruku [173-5]</option><option value="63">Juma Kupewa [176-8]</option><option value="64">Leila Samson [85-1]</option><option value="65">Ramadhan Katala [177-6]</option><option value="66">Elizabeth Dotto Kagwese [179-2]</option><option value="67">Lulu Wilson Ismael [180-0]</option><option value="68">Rabson Namtwanga [181-8]</option><option value="69">Belina Byabato [182-6]</option><option value="70">Sturida Patrick [183-4]</option><option value="71">Florent Raphael Heritier [184-2]</option><option value="72">Happyphania Isaya Ngakongwa [167-7]</option><option value="3">Herry Robert Mapesi [14]</option><option value="174">Jerome Lwali [174]</option><option value="173">Mohamed Godfrey Mbaruku [173]</option><option value="171">Yvonne Ramesh Haridas [171]</option><option value="165">Francisca Seraphin Chuwa [165]</option><option value="111">Robert Christopher Ndege [111]</option><option value="125">Sambuta Aloyce [125]</option><option value="87">Leila Samson [87]</option><option value="170">Jacqueline Inoja Nkouabi [170]</option><option value="178">Deogratius Nzaligo [178]</option><option value="179">Elizabeth Dotto Kagwese [179]</option><option value="180">Lulu Wilson Ismael [180]</option><option value="117">Lilian Moshi [117]</option><option value="105">Ezekiel Luoga [105]</option><option value="181">Rabson Namtwanga [181]</option><option value="184">Florent Raphael Heritier [184]</option><option value="167">Happyphania Isaya Ngakongwa [167]</option><option value="86">Regina Ndaki [86]</option><option value="100">Maja Weisser [100]</option><option value="106">Sharifa Nakapala [106]</option><option value="185">Petro Togolani Sabuni [185]</option><option value="187">Namsifueli Julius Ley [187]</option><option value="188">Bedran Topyurek [188]</option><option value="190">Fredy Geiger [190]</option><option value="176">Juma Kupewa [176]</option><option value="193">Getruda Lenia Julius [193]</option><option value="194">Florian Kasper Mury [194]</option><option value="195">Sara Glanzmann [195]</option><option value="196">Benjamin Yannick Bissmann [196]</option><option value="172">Suzan Ngalimecha Ngahyoma [172]</option><option value="197" selected="selected">Emanuel Ally Nyenza [197]</option><option value="198">Franzisca Alfred Mmbando [198]</option><option value="116">Farida Bani [116]</option></select></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 822px; position: absolute; left: 48px; top: 51px;"><tbody><tr><td align="left" style="vertical-align: top;"><div style="position: relative; overflow: hidden; width: 822px; height: 1406px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; border-style: dashed; border-width: 1px; border-color: rgb(26, 172, 155);" class="purcforms-group-border"><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 100%; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Header Label" style="width: 100%; height: 20px; line-height: 20px; color: white; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif; text-align: center; background-color: rgb(26, 172, 155);"> GBV QUESTIONS</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 31px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/gbv_screen/value" id="gwt-uid-44" tabindex="0"><label for="gwt-uid-44"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 147px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 76px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: 0px; top: 217px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -2px; top: 287px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 157px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/emotional/value" id="gwt-uid-45" tabindex="0" disabled="disabled"><label for="gwt-uid-45"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 85px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/gbv_any/value" id="gwt-uid-46" tabindex="0" checked="checked"><label for="gwt-uid-46"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 361px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 429px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -2px; top: 497px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 563px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 300px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/physical/value" id="gwt-uid-47" tabindex="0" disabled="disabled"><label for="gwt-uid-47"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 438px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/unwill_sex/value" id="gwt-uid-48" tabindex="0" disabled="disabled"><label for="gwt-uid-48"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 16px; top: 509px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 575px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/danger_sex/value" id="gwt-uid-49" tabindex="0" disabled="disabled"><label for="gwt-uid-49"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -3px; top: 639px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 788px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -3px; top: 711px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 859px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 14px; top: 656px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="height: 2px; line-height: 2px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 724px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/unwill_preg/value" id="gwt-uid-50" tabindex="0" disabled="disabled"><label for="gwt-uid-50"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 13px; top: 798px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 867px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/forced_marriage/value" id="gwt-uid-51" tabindex="0" disabled="disabled"><label for="gwt-uid-51"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -2px; top: 921px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -3px; top: 983px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 1048px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -2px; top: 1119px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: 0px; top: 1185px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 12px; top: 932px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 996px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/force_abort/value" id="gwt-uid-52" tabindex="0" disabled="disabled"><label for="gwt-uid-52"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 14px; top: 1061px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 1133px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/verbal/value" id="gwt-uid-53" tabindex="0" disabled="disabled"><label for="gwt-uid-53"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 17px; top: 1197px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 1251px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 824px; left: -1px; top: 1342px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-horizontal-grid-line" style="border-style: solid none none solid; border-width: 1px; width: 824px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 545px; top: 18px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="purcforms-vertical-grid-line" style="border-style: solid none none solid; border-width: 1px; height: 1385px; line-height: 1385px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 15px; top: 1357px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Are you afraid of anyone of the people you mention above?" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Are you afraid of anyone of the people you mention above?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 15px; top: 369px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 512px; left: 15px; top: 300px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="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?" style="width: 512px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> 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?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 11px; top: 438px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="In the past 12 months, were you forced to have sex against your will?" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> In the past 12 months, were you forced to have sex against your will?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 515px; left: 14px; top: 575px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="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?" style="width: 515px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> 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?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 515px; left: 12px; top: 724px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="In the past 12 months, were you physically forced or made to feel that you had to become pregnant against your will?" style="width: 515px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> In the past 12 months, were you physically forced or made to feel that you had to become pregnant against your will?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 11px; top: 867px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="In the past 12 months, were you coerced or forced into marriage?" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> In the past 12 months, were you coerced or forced into marriage?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 12px; top: 996px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="In the past 12 months, were you coerced or forced to have an abortion?" style="height: 0px; line-height: 0px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> In the past 12 months, were you coerced or forced to have an abortion?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 508px; left: 17px; top: 1133px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="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?" style="width: 508px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> 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?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 509px; left: 17px; top: 1259px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="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?" style="width: 509px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> 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?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 560px; top: 1259px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="NO" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/controlling/value" id="gwt-uid-54" tabindex="0" disabled="disabled"><label for="gwt-uid-54"> No</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 12px; top: 31px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="Patient screened for GBV? If yes, respond YES/NO to the following questions" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> Patient screen for GBV?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 16px; top: 85px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="In the past 12 months did you experience any GBV?" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> In the past 12 months did you experience any GBV?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 519px; left: 10px; top: 157px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="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?" style="width: 519px; font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> 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?</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 14px; top: 228px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><div class="gwt-Label" title="If yes, by whom (relationship not a name)" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"> If yes, by whom (relationship not a name)</div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 31px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/gbv_screen/value" id="gwt-uid-55" tabindex="0" checked="checked"><label for="gwt-uid-55"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 85px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/gbv_any/value" id="gwt-uid-56" tabindex="0"><label for="gwt-uid-56"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 157px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/emotional/value" id="gwt-uid-57" tabindex="0" disabled="disabled"><label for="gwt-uid-57"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 300px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/physical/value" id="gwt-uid-58" tabindex="0" disabled="disabled"><label for="gwt-uid-58"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 438px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/unwill_sex/value" id="gwt-uid-59" tabindex="0" disabled="disabled"><label for="gwt-uid-59"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 575px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/danger_sex/value" id="gwt-uid-60" tabindex="0" disabled="disabled"><label for="gwt-uid-60"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 724px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/unwill_preg/value" id="gwt-uid-61" tabindex="0" disabled="disabled"><label for="gwt-uid-61"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 867px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/forced_marriage/value" id="gwt-uid-62" tabindex="0" disabled="disabled"><label for="gwt-uid-62"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 996px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/force_abort/value" id="gwt-uid-63" tabindex="0" disabled="disabled"><label for="gwt-uid-63"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 1133px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/verbal/value" id="gwt-uid-64" tabindex="0" disabled="disabled"><label for="gwt-uid-64"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="left: 720px; top: 1259px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><span class="gwt-RadioButton gwt-RadioButton-disabled" title="YES" style="font-weight: bold; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;"><input type="radio" name="obs/controlling/value" id="gwt-uid-65" tabindex="0" disabled="disabled"><label for="gwt-uid-65"> Yes</label></span></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 224px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="17" title="If yes, by whom (relationship not a name)" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_emotional/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 368px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="27" title="If yes, by whom (relationship not a name)" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_physical/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 503px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="32" title="If yes, by whom (relationship not a name)" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_unwill_sex/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 646px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="40" title="If yes, by whom (relationship not a name)" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_danger_sex/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 794px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="45" title="If yes, by whom (relationship not a name)" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_unwill_preg/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 926px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="57" title="If yes, by whom (relationship not a name)" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_force_marriage/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 261px; left: 553px; top: 1054px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="62" title="If yes, by whom (relationship not a name)" style="width: 261px; height: 58px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_force_abort/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 1191px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="67" title="If yes, by whom (relationship not a name)" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_verbal/value" disabled="disabled"></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 260px; left: 553px; top: 1347px; position: absolute;"><tbody><tr><td align="left" style="vertical-align: top;"><input type="text" class="gwt-TextBox" tabindex="71" title="Are you afraid of anyone of the people you mention above?" style="width: 260px; height: 52px; font-size: 12px; font-family: Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif;" id="obs/yes_controlling/value" disabled="disabled"></td></tr></tbody></table></div></td></tr></tbody></table><table cellspacing="0" cellpadding="0" class="gwt-PanelTable" style="width: 70px; position: absolute; left: 650px; top: 1486px;"><tbody><tr><td align="left" style="vertical-align: top;"><button type="button" class="gwt-Button" tabindex="34" title="submit" style="width: 70px; 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  351. </div>
  352. <div id="searchProviders" style="height: 0px; width: 0px; visibility: hidden;">
  353. <input type="text" id="providerId_id_selection">
  354. </div>
  355. <div id="searchPersons" style="height: 0px; width: 0px; visibility: hidden;">
  356. <input type="text" id="personId_id_selection">
  357. </div>
  358. <div id="searchLocations" style="height: 0px; width: 0px; visibility: hidden;">
  359. <input type="text" id="locationId_id_selection" onblur="updateLocationFields(this)" placeholder="Enter location name" class="ui-autocomplete-input" autocomplete="off" role="textbox" aria-autocomplete="list" aria-haspopup="true">
  360. </div>
  361. <script type="text/javascript">
  362. var jsDateFormat = 'mm/dd/yyyy';
  363. var jsLocale = 'en';
  364.  
  365. var locationNameIdMap = new Object();
  366. var locationNames = [];
  367.  
  368. locationNames.push("Unknown Location");
  369. locationNameIdMap["Unknown Location"] = "1";
  370.  
  371.  
  372. $j('input#locationId_id_selection').autocomplete({
  373. source: locationNames,
  374. select: function(event, ui) {
  375. valElement.value = ui.item.value;
  376. txtElement.innerHTML = locationNameIdMap[ui.item.value];
  377.  
  378. var parent = searchElement.parentNode;
  379. parent.removeChild(searchElement);
  380. parent.appendChild(valElement);
  381.  
  382. valElement.focus();
  383. }
  384. });
  385.  
  386. function updateLocationFields(searchField){
  387. if(locationNameIdMap[$j.trim($j(searchField).val())] == undefined)
  388. $j(searchField).val('');
  389. if($j.trim($j(searchField).val()) == '')
  390. $j(valElement).val('');
  391. }
  392. </script>
  393.  
  394.  
  395.  
  396.  
  397. <script language="javascript">
  398.  
  399. var searchElement;
  400. var conceptSearchElement;
  401. var providerSearchElement;
  402. var locationSearchElement;
  403. var personSearchElement;
  404. var options;
  405.  
  406. var PurcformsText = {
  407. file: "File",
  408. view: "View",
  409. item: "Item",
  410. tools: "Tools",
  411. help: "Help",
  412. newItem: "New",
  413. open: "Open",
  414. save: "Save",
  415. saveAs: "Save As",
  416.  
  417. openLayout: "xforms.foropenLayoutms",
  418. saveLayout: "Save Layout",
  419. openLanguageText: "Open Language Text",
  420. saveLanguageText: "Save Language Text",
  421. close: "Close",
  422.  
  423. refresh: "Refresh",
  424. addNew: "Add New",
  425. addNewChild: "Add New Child",
  426. deleteSelected: "xforms.deleteSelected",
  427. moveUp: "Move Up",
  428. moveDown: "Move Down",
  429. cut: "Cut",
  430. copy: "Copy",
  431. paste: "Paste",
  432.  
  433. format: "Format",
  434. languages: "Languages",
  435. options: "Options",
  436.  
  437. helpContents: "Help Contents",
  438. about: "About",
  439.  
  440. forms: "Form Fields",
  441. widgetProperties: "Widget Properties",
  442. properties: "Properties",
  443. xformsSource: "Xforms Xml",
  444. designSurface: "Design Surface",
  445. layoutXml: "Layout Xml",
  446. languageXml: "Language Xml",
  447. preview: "Preview",
  448. modelXml: "Model",
  449.  
  450. text: "Text",
  451. helpText: "Help Text",
  452. type: "Type",
  453. binding: "Binding",
  454. visible: "Visible",
  455. enabled: "Enabled",
  456. locked: "Locked",
  457. required: "Required",
  458. defaultValue: "Default Value",
  459. descriptionTemplate: "Description Template",
  460.  
  461. language: "Language",
  462. skipLogic: "Skip Logic",
  463. validationLogic: "Validation Logic",
  464. dynamicLists: "Dynamic Lists",
  465.  
  466. valuesFor: "Values for: ",
  467. whenAnswerFor: "when the answer for: ",
  468. isEqualTo: "is equal to",
  469. forQuestion: "For question: ",
  470. enable: "Enable",
  471. disable: "Disable",
  472. show: "Show",
  473. hide: "Hide",
  474. makeRequired: "Make Required",
  475.  
  476. when: "When ",
  477. ofTheFollowingApply: "of the following apply",
  478. all: "all",
  479. any: "any",
  480. none: "none",
  481. notAll: "not all",
  482.  
  483. addNewCondition: "Click here to add new condition",
  484.  
  485. isEqualTo: "is equal to",
  486. isNotEqual: "is not equal to",
  487. isLessThan: "is less than",
  488. isLessThanOrEqual: "is less than or equal to",
  489. isGreaterThan: "is greater than",
  490. isGreaterThanOrEqual: "is greater than or equal to",
  491. isNull: "is null",
  492. isNotNull: "is not null",
  493. isInList: "is in list",
  494. isNotInList: "is not in list",
  495. startsWith: "starts with",
  496. doesNotStartWith: "does not start with",
  497. endsWith: "ends with",
  498. doesNotEndWith: "does not end with",
  499. contains: "contains",
  500. doesNotContain: "does not contain",
  501. isBetween: "is between",
  502. isNotBetween: "is not between",
  503.  
  504. isValidWhen: "is valid when",
  505. errorMessage: "Error Message:",
  506. question: "Question",
  507.  
  508. addField: "Add Field",
  509. submit: "Submit",
  510. addWidget: "Add Widget",
  511. newTab: "New Tab",
  512. deleteTab: "Delete Tab",
  513. selectAll: "Select All",
  514. load: "Load",
  515.  
  516. label: "Label",
  517. textBox: "TextBox",
  518. checkBox: "CheckBox",
  519. radioButton: "RadioButton",
  520. dropdownList: "DropdownList",
  521. textArea: "TextArea",
  522. button: "Button",
  523. datePicker: "Date Picker",
  524. groupBox: "Group Box",
  525. repeatSection: "Repeat Section",
  526. picture: "Picture",
  527. videoAudio: "Video/Audio",
  528. listBox: "ListBox",
  529.  
  530. deleteWidgetPrompt: "Do you really want to delete the selected Widget (s)?",
  531. deleteTreeItemPrompt: "Do you really want to delete the selected item and all its children (if any) ?",
  532. selectDeleteItem: "Please first select the item to delete",
  533.  
  534. selectedPage: "The selected page [",
  535. shouldNotSharePageBinding: "should not share the same page number/binding with page [",
  536. selectedQuestion: "The selected question",
  537. shouldNotShareQuestionBinding: "should not share the same binding with question",
  538. selectedOption: "The selected option",
  539. shouldNotShareOptionBinding: "should not share the same binding with option",
  540. newForm: "New Form",
  541. page: "Page",
  542. option: "Option",
  543. noDataFound: "No data found.",
  544.  
  545. formSaveSuccess: "Form saved successfully",
  546. selectSaveItem: "Please select the item to save.",
  547. deleteAllWidgetsFirst: "Please first delete all the widgets.",
  548. deleteAllTabWidgetsFirst: "This tab has one or more widgets, please first delete them",
  549. cantDeleteAllTabs: "This tab cannot be deleted because there should be atleast one tab.",
  550. noFormId: "No formId or ",
  551. divFound: "No formId or ",
  552. noFormLayout: "No form layout found. Please first open the form in the form designer, then click the Design Surface tab and ensure that you have some widgets loaded. Then save the form and try again.",
  553. formSubmitSuccess: "Form Data Submitted Successfully",
  554. missingDataNode: "Missing data node for :",
  555.  
  556. openingForm: "Opening Form",
  557. openingFormLayout: "Opening Form Layout",
  558. savingForm: "Saving Form",
  559. savingFormLayout: "Saving Form Layout",
  560. refreshingForm: "Refreshing Form",
  561. translatingFormLanguage: "Translating Form Language",
  562. savingLanguageText: "Saving Language Text",
  563. refreshingDesignSurface: "Refreshing Design Surface",
  564. loadingDesignSurface: "Loading Design Surface",
  565. refreshingPreview: "Refreshing Preview",
  566.  
  567. count: "Count",
  568. clickToPlay: "Click to play",
  569. loadingPreview: "Loading Preview",
  570. unexpectedFailure: "Unexpected Failure",
  571. uncaughtException: "Uncaught exception: ",
  572. causedBy: "Caused by: ",
  573. openFile: "Open File",
  574. saveFileAs: "Save File As",
  575.  
  576. alignLeft: "Align Left",
  577. alignRight: "Align Right",
  578. alignTop: "Align Top",
  579. alignBottom: "Align Bottom",
  580. makeSameWidth: "Make Same Width",
  581. makeSameHeight: "Make Same Height",
  582. makeSameSize: "Make Same Size",
  583. layout: "Layout",
  584. deleteTabPrompt: "Do you really want to delete this tab?",
  585.  
  586. text: "Text",
  587. toolTip: "Tooltip",
  588. childBinding: "Child Binding",
  589. width: "Width",
  590. height: "Height",
  591. left: "Left",
  592. top: "Top",
  593. tabIndex: "Tab Index",
  594. repeat: "Repeat",
  595. externalSource: "External Source",
  596. displayField: "Display Field",
  597. valueField: "Value Field",
  598. fontFamily: "Font Family",
  599. foreColor: "Fore Color",
  600. fontWeight: "Font Weight",
  601. fontStyle: "Font Style",
  602. fontSize: "Font Size",
  603. textDecoration: "Text Decoration",
  604. textAlign: "Text Align",
  605. backgroundColor: "Background Color",
  606. borderStyle: "Border Style",
  607. borderWidth: "Border Width",
  608. borderColor: "Border Color",
  609. aboutMessage: "This is a form designer widget based on GWT",
  610. more: "More",
  611. requiredErrorMsg: "Please answer this required question.",
  612. questionTextDesc: "The question text",
  613. questionDescDesc: "The question description",
  614. questionIdDesc: "The question internal identifier. For Questions, it should be a valid xml node name.",
  615. defaultValDesc: "The default value or answer",
  616. questionTypeDesc: "The type of question or type of expected answers.",
  617. qtnTypeText: "Text",
  618. qtnTypeNumber: "Number",
  619. qtnTypeDecimal: "Decimal",
  620. qtnTypeDate: "Date",
  621. qtnTypeTime: "Time",
  622. qtnTypeDateTime: "Date and Time",
  623. qtnTypeBoolean: "Boolean",
  624. qtnTypeSingleSelect: "Single Select",
  625. qtnTypeMultSelect: "Multiple Select",
  626. qtnTypeRepeat: "Repeat",
  627. qtnTypePicture: "Picture",
  628. qtnTypeVideo: "Video",
  629. qtnTypeAudio: "Audio",
  630. qtnTypeSingleSelectDynamic: "Single Select Dynamic",
  631. deleteCondition: "Delete Condition",
  632. addCondition: "Add Condition",
  633. value: "Value",
  634. questionValue: "Question value",
  635. and: "and",
  636. deleteItemPrompt: "Do you really want to delete this item?",
  637. changeWidgetTypePrompt: "Do you really want to change to this type and lose all the options created, if any?",
  638. removeRowPrompt: "Do you really want to remove this row?",
  639. remove: "Remove",
  640. browse: "Browse",
  641. clear: "Clear",
  642. deleteItem: "Delete",
  643. cancel: "Cancel",
  644. clickToAddNewCondition: "&lt; Click here to add new condition &gt;",
  645. qtnTypeGPS: "GPS",
  646. qtnTypeBarcode: "Barcode",
  647. qtnTypeGroup: "Group",
  648. palette: "Palette",
  649. saveAsXhtml: "Save As XHTML",
  650. groupWidgets: "Group Widgets",
  651. action: "Action",
  652. submitting: "Submitting",
  653. authenticationPrompt: "Please enter your user name and password",
  654. invalidUser: "Invalid UserName or Password",
  655. login: "Login",
  656. userName: "User Name",
  657. password: "Password",
  658. noSelection: "NO SELECTION",
  659. cancelFormPrompt: "Do you really want to Cancel and Discard changes on this form, if any?",
  660. print: "Print",
  661. yes: "Yes",
  662. no: "No",
  663. searchServer: "Search Server",
  664. recording: "Recording",
  665. search: "Search",
  666. processingMsg: "Please wait while processing...",
  667. length: "Length",
  668. clickForOtherQuestions: "&lt; Click here for other questions &gt;",
  669. ok: "Ok",
  670. undo: "Undo",
  671. redo: "Redo",
  672. loading: "loading",
  673. allQuestions: "All Questions",
  674. selectedQuestions: "Selected Questions",
  675. otherQuestions: "Other Questions",
  676. wrongFormat: "Wrong format. Expected format",
  677. timeWidget: "Time Widget",
  678. dateTimeWidget: "Date Time Widget",
  679. lockWidgets: "Lock",
  680. unLockWidgets: "Unlock",
  681. changeWidgetH: "Change to Horizontal Radio Buttons",
  682. changeWidgetV: "Change to Vertical Radio Buttons",
  683. changeToTextBoxWidget: "Change to TextBox",
  684. saveAsPurcForm: "Save As",
  685. localeChangePrompt: "Changing locale will lead to loss of any unsaved changes. Do you want to go ahead and change?",
  686. javaScriptSource: "JavaScript",
  687. calculation: "Calculation",
  688. id: "ID",
  689. formKey: "Form Key",
  690. logo: "Logo",
  691. filterField: "Filter Field",
  692. table: "Table",
  693. horizontalLine: "Horizontal Line",
  694. verticalLine: "Vertical Line",
  695. addRowsBelow: "Add Rows Below",
  696. addRowsAbove: "Add Rows Above",
  697. addColumnsRight: "Add Columns Right",
  698. addColumnsLeft: "Add Columns Left",
  699. numberOfRowsPrompt: "Please enter the number of rows",
  700. numberOfColumnsPrompt: "Please enter the number of columns",
  701. deleteColumn: "Delete Column",
  702. deleteRow: "Delete Row",
  703. repeatChildDataNodeNotFound: "Please first save the form, and then refresh the Preview surface. Or check the question bindings on the properties tab.",
  704. selectedFormField: "Selected Form Field",
  705. edit: "Edit",
  706. find: "Find",
  707. css: "CSS",
  708. bold: "Bold",
  709. italic: "Italic",
  710. underline: "Underline",
  711. mergeCells: "Merge Cells",
  712. exclusiveOption: "Exclusive Option",
  713. otherProperties: "Others",
  714. exclusiveQuestion: "Exclusive Question",
  715. cls: "Class",
  716. deleteFormPrompt: "Do you really want to delete this encounter?"
  717. };
  718.  
  719. function searchExternal(key,value,parentElement,textElement,valueElement,filterField){
  720. if (key == 'date') {
  721. showCalendar(valueElement, 100);
  722. return;
  723. }
  724. else if (key == 'datetime') {
  725. showDateTimePicker(valueElement, 100);
  726. return;
  727. }
  728. else if (key == 'time') {
  729. showTimePicker(valueElement, 100);
  730. return;
  731. }
  732.  
  733. if (typeof(dojo) != "undefined"){
  734. var searchWidget = dojo.widget.manager.getWidgetById("conceptId_search");
  735. //parentElement.appendChild(searchWidget.domNode.parentNode);
  736. searchWidget.includeClasses = (filterField == null ? [] : filterField.split(","));
  737.  
  738. var selectionWidget = dojo.widget.manager.getWidgetById("conceptId_selection");
  739. selectionWidget.displayNode = textElement;
  740.  
  741. selectionWidget.hiddenInputNode = valueElement;
  742.  
  743. searchWidget.clearSearch();
  744. searchWidget.toggleShowing();
  745.  
  746.  
  747. var left = dojo.style.totalOffsetLeft(parentElement.parentNode, false) + dojo.style.getBorderBoxWidth(parentElement.parentNode) + 10;
  748. if (left + dojo.style.getBorderBoxWidth(searchWidget.domNode) > dojo.html.getViewportWidth())
  749. left = dojo.html.getViewportWidth() - dojo.style.getBorderBoxWidth(searchWidget.domNode) - 10 + dojo.html.getScrollLeft();
  750.  
  751. var top = dojo.style.totalOffsetTop(parentElement.parentNode, true);
  752. var scrollTop = dojo.html.getScrollTop();
  753. var boxHeight = dojo.style.getBorderBoxHeight(searchWidget.domNode);
  754. var viewportHeight = dojo.html.getViewportHeight();
  755. if ((top + boxHeight - scrollTop) > viewportHeight - 5)
  756. top = viewportHeight - boxHeight + scrollTop - 10;
  757.  
  758. dojo.style.setPositivePixelValue(searchWidget.domNode, "top", top);
  759.  
  760. dojo.style.setPositivePixelValue(searchWidget.domNode, "left", left);
  761.  
  762. searchWidget.inputNode.select();
  763. searchWidget.inputNode.value = value;
  764. }
  765. else{
  766. key = $j.trim(key).toLowerCase();
  767. if(key != 'concept' && key != 'location' && key != 'provider' && key != 'person'){
  768. alert("The external source property '"+key+"' is invalid, you need to specify the appropriate one "+
  769. "from the following from the xforms design page: concept, location, provider and person");
  770. return;
  771. }
  772.  
  773. //If we had previously displayed a search widget, remove it and add the original value widget.
  774. if (searchElement != null) {
  775. var parent = searchElement.parentNode;
  776. if (parent != null) {
  777. parent.removeChild(searchElement);
  778. parent.appendChild(valElement);
  779. }
  780. }
  781.  
  782. valElement = valueElement;
  783. txtElement = textElement;
  784.  
  785. var searchInputId;
  786. var placeHolderText;
  787. var callback;
  788. var createCallback;
  789. var isSearchElementNull = false;
  790. if(key == 'concept'){
  791. searchInputId = 'conceptId_id_selection';
  792. placeHolderText = 'Enter concept name or id';
  793. var includeC = (filterField == null ? "" : filterField).split(",");
  794. var excludeC = "".split(",");
  795. var includeD = "".split(",");
  796. var excludeD = "".split(",");
  797.  
  798. // the typical callback
  799. if (options == null)
  800. options = {includeClasses:includeC, excludeClasses:excludeC, includeDatatypes:includeD, excludeDatatypes:excludeD};
  801. else
  802. options.includeClasses = includeC;
  803.  
  804. createCallback = new CreateCallback(options);
  805. callback = createCallback.conceptCallback();
  806. if(conceptSearchElement == null){
  807. isSearchElementNull = true;
  808. conceptSearchElement = document.getElementById(searchInputId);
  809. }
  810. searchElement = conceptSearchElement;
  811. }else if(key == 'provider'){
  812. searchInputId = 'providerId_id_selection';
  813. placeHolderText = 'Provider name or ID';
  814. callback = new CreateCallback().providerCallback();
  815. if(providerSearchElement == null){
  816. isSearchElementNull = true;
  817. providerSearchElement = document.getElementById(searchInputId);
  818. }
  819. searchElement = providerSearchElement;
  820. }else if(key == 'person'){
  821. searchInputId = 'personId_id_selection';
  822. placeHolderText = 'Enter person name or id';
  823. callback = new CreateCallback().personCallback();
  824. if(personSearchElement == null){
  825. isSearchElementNull = true;
  826. personSearchElement = document.getElementById(searchInputId);
  827. }
  828. searchElement = personSearchElement;
  829. }else if(key == 'location'){
  830. if(locationSearchElement == null){
  831. isSearchElementNull = true;
  832. locationSearchElement = document.getElementById('locationId_id_selection');
  833. }
  834. searchElement = locationSearchElement;
  835. }
  836.  
  837. if (createCallback) {
  838. // a 'private' method
  839. // This is what maps each ConceptListItem or LocationListItem returned object to a name in the dropdown
  840. createCallback.displayNamedObject = function(origQuery) { return function(item) {
  841. // dwr sometimes puts strings into the results, just display those
  842. if (typeof item == 'string') {
  843. item += "<a href='#proposeConcept' onclick='javascript:return showProposeConceptForm();'> Possible new concept? </a>";
  844. return { label: item, value: "" };
  845. }
  846.  
  847. // item is a ConceptListItem or LocationListItem object
  848. // add a space so the term highlighter below thinks the first word is a word
  849. var textShown = " " + item.name;
  850.  
  851. // highlight each search term in the results
  852. textShown = highlightWords(textShown, origQuery);
  853.  
  854. var value = item.name;
  855. if (item.preferredName) {
  856. textShown += "<span class='preferredname'> &rArr; " + item.preferredName + "</span>";
  857. //value = item.preferredName;
  858. }
  859.  
  860. textShown = "<span class='autocompleteresult'>" + textShown + "</span>";
  861.  
  862. return { label: textShown, value: value, object: item};
  863. }; };
  864. }
  865.  
  866. //we use a custom autocomplete for location widget since there is
  867. //no autocomplete call back for locations in the core
  868. if(key != 'location'){
  869. // set up the autocomplete
  870. new AutoComplete(searchInputId, callback, {
  871. select: function(event, ui) {
  872. if (ui.item.object) {
  873. funcItemIdAutoCompleteOnSelect(ui.item.object, ui.item, key);
  874. }
  875. },
  876. placeholder:placeHolderText,
  877. autoSelect: true
  878. });
  879. }
  880.  
  881. if(isSearchElementNull == true)
  882. searchElement.parentNode.removeChild(searchElement);
  883.  
  884. searchElement.style.height = valueElement.parentNode.parentNode.parentNode.parentNode.style.height;
  885. searchElement.style.width = valueElement.parentNode.parentNode.parentNode.parentNode.style.width;
  886.  
  887. var parent = valueElement.parentNode;
  888. parent.removeChild(valueElement);
  889.  
  890. parent.appendChild(searchElement);
  891. searchElement.focus();
  892. searchElement.value = value;
  893. }
  894. }
  895.  
  896. function isUserAuthenticated(){
  897. DWRXformsService.isAuthenticated(checkIfLoggedInCallback);
  898. }
  899.  
  900. function authenticateUser(username, password){
  901. DWRXformsService.authenticate(username,password,checkIfLoggedInCallback);
  902. }
  903.  
  904. function checkIfLoggedInCallback(isLoggedIn) {
  905. authenticationCallback(isLoggedIn);
  906. }
  907.  
  908. function initialize(){
  909. //var selectionWidget = dojo.widget.manager.getWidgetById("conceptId_selection");
  910. //selectionWidget.changeButton.style.display = "none";
  911.  
  912. if (typeof(dojo) != "undefined"){
  913.  
  914. dojo.addOnLoad( function() {
  915. dojo.event.topic.subscribe("conceptId_search/select",
  916. function(msg) {
  917. if (msg) {
  918. var concept = msg.objs[0];
  919. var conceptPopup = dojo.widget.manager.getWidgetById("conceptId_selection");
  920. conceptPopup.displayNode.innerHTML = concept.conceptId + "^" + concept.name + "^99DCT";
  921. conceptPopup.hiddenInputNode.value = concept.name;
  922. conceptPopup.hiddenInputNode.focus();
  923. }
  924. }
  925. );
  926. })
  927.  
  928. }
  929. else{
  930. document.getElementById("searchConcepts").style.visibility="hidden";
  931. document.getElementById("searchProviders").style.visibility="hidden";
  932. document.getElementById("searchPersons").style.visibility="hidden";
  933. document.getElementById("searchLocations").style.visibility="hidden";
  934. }
  935. }
  936.  
  937. function funcItemIdAutoCompleteOnSelect(selectedObj, item, key) {
  938. if(key == 'concept'){
  939. valElement.value = selectedObj.name;
  940. txtElement.innerHTML = selectedObj.conceptId + "^" + selectedObj.name + "^99DCT";
  941. }else if(key == 'provider'){
  942. valElement.value = selectedObj.displayName;
  943. txtElement.innerHTML = selectedObj.providerId;
  944. }else if(key == 'person'){
  945. valElement.value = selectedObj.personName;
  946. txtElement.innerHTML = selectedObj.uuid;
  947. }
  948.  
  949. var parent = searchElement.parentNode;
  950. parent.removeChild(searchElement);
  951. parent.appendChild(valElement);
  952.  
  953. valElement.focus();
  954.  
  955. searchElement = null;
  956. valElement = null;
  957. }
  958.  
  959.  
  960. function showProposeConceptForm() {
  961. $j('#proposedText').val("");
  962. $j('#proposeConceptForm').dialog('open');
  963. document.getElementById('proposedText').focus();
  964. $j('#proposedText').focus();
  965.  
  966. return false;
  967. }
  968.  
  969. /*
  970. * Private method, used when display persons or concepts to show
  971. * which part of the word was a match.
  972. *
  973. * Each separate word in "origQuery" will be highlighted with a 'hit' class in
  974. * the "textShown" string.
  975. */
  976. function highlightWords(textShown, origQuery) {
  977. var words = origQuery.split(" ");
  978. for (var x=0; x<words.length; x++) {
  979. if (jQuery.trim(words[x]).length > 0) {
  980. var word = " " + words[x]; // only match the beginning of words
  981. // replace each occurrence case insensitively while replacing with original case
  982. textShown = textShown.replace(word, function(matchedTxt) { return "{{{{" + matchedTxt + "}}}}"}, "gi");
  983. }
  984. }
  985.  
  986. textShown = textShown.replace(/{{{{/g, "<span class='hit'>");
  987. textShown = textShown.replace(/}}}}/g, "</span>");
  988.  
  989. return textShown;
  990. }
  991.  
  992. function proposeConcept() {
  993. var box = document.getElementById('proposedText');
  994. if (box.value == '') {
  995. alert("Proposed Concept text must be entered. Or simply click Cancel");
  996. box.focus();
  997. }
  998. else {
  999. $j('#proposeConceptForm').dialog("close");
  1000. DWRConceptService.findProposedConcepts(box.value, preProposedConcepts);
  1001. }
  1002. }
  1003.  
  1004. function preProposedConcepts(concepts) {
  1005. if (concepts.length == 0) {
  1006. var conceptName = document.getElementById('proposedText').value;
  1007. valElement.value = conceptName;
  1008. txtElement.innerHTML = 'PROPOSED' + "^" + conceptName + "^99DCT";
  1009. var parent = searchElement.parentNode;
  1010. parent.removeChild(searchElement);
  1011. parent.appendChild(valElement);
  1012.  
  1013. valElement.focus();
  1014.  
  1015. searchElement = null;
  1016. valElement = null;
  1017. }
  1018. else {
  1019. //display a box telling them to pick a preposed concept:
  1020. alert('These concepts were proposed and accepted with the same text.');
  1021. removeAutoCompleteWidget();
  1022. }
  1023. }
  1024.  
  1025. function removeAutoCompleteWidget() {
  1026. var parent = searchElement.parentNode;
  1027. parent.removeChild(searchElement);
  1028. parent.appendChild(valElement);
  1029. valElement.focus();
  1030.  
  1031. searchElement = null;
  1032. valElement = null;
  1033. }
  1034.  
  1035. $j(document).ready(function() {
  1036. $j('#proposeConceptForm').dialog({
  1037. autoOpen: false,
  1038. modal: true,
  1039. title: 'Propose New Concept',
  1040. width: '30%',
  1041. zIndex: 100,
  1042. close: function() { $j("#problem_concept").autocomplete("close"); },
  1043. buttons: { 'Submit Concept': function() { proposeConcept(); },
  1044. 'Cancel': function() { $j(this).dialog("close"); removeAutoCompleteWidget();}
  1045. }
  1046. });
  1047.  
  1048. });
  1049.  
  1050. </script>
  1051.  
  1052. </div></div><ul class="ui-autocomplete ui-menu ui-widget ui-widget-content ui-corner-all" role="listbox" aria-activedescendant="ui-active-menuitem" style="z-index: 1; top: 0px; left: 0px; display: none;"></ul><div style="display: none; z-index: 100; outline: 0px; position: absolute;" class="ui-dialog ui-widget ui-widget-content ui-corner-all ui-draggable ui-resizable" tabindex="-1" role="dialog" aria-labelledby="ui-dialog-title-proposeConceptForm"><div class="ui-dialog-titlebar ui-widget-header ui-corner-all ui-helper-clearfix" unselectable="on" style="user-select: none;"><span class="ui-dialog-title" id="ui-dialog-title-proposeConceptForm" unselectable="on" style="user-select: none;">Propose New Concept</span><a href="#" class="ui-dialog-titlebar-close ui-corner-all" role="button" unselectable="on" style="user-select: none;"><span class="ui-icon ui-icon-closethick" unselectable="on" style="user-select: none;">close</span></a></div><div id="proposeConceptForm" style="display: block;" class="ui-dialog-content ui-widget-content">
  1053. <br>
  1054. Please provide the text that was written on the form. All comments that you additionally provide will be appreciated.
  1055. <br><br>
  1056. <b>Original Text</b><br>
  1057. <textarea name="originalText" id="proposedText" rows="4" cols="60"></textarea><br>
  1058. <br>
  1059. <span class="alert">
  1060. This text will be saved temporarily until an administrator can review it and add it to the list.
  1061. </span>
  1062. </div><div class="ui-resizable-handle ui-resizable-n" unselectable="on" style="user-select: none;"></div><div class="ui-resizable-handle ui-resizable-e" unselectable="on" style="user-select: none;"></div><div class="ui-resizable-handle ui-resizable-s" unselectable="on" style="user-select: none;"></div><div class="ui-resizable-handle ui-resizable-w" unselectable="on" style="user-select: none;"></div><div class="ui-resizable-handle ui-resizable-se ui-icon ui-icon-gripsmall-diagonal-se ui-icon-grip-diagonal-se" style="z-index: 1001; user-select: none;" unselectable="on"></div><div class="ui-resizable-handle ui-resizable-sw" style="z-index: 1002; user-select: none;" unselectable="on"></div><div class="ui-resizable-handle ui-resizable-ne" style="z-index: 1003; user-select: none;" unselectable="on"></div><div class="ui-resizable-handle ui-resizable-nw" style="z-index: 1004; user-select: none;" unselectable="on"></div><div class="ui-dialog-buttonpane ui-widget-content ui-helper-clearfix"><button type="button" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only" role="button" aria-disabled="false"><span class="ui-button-text">Submit Concept</span></button><button type="button" class="ui-button ui-widget ui-state-default ui-corner-all ui-button-text-only" role="button" aria-disabled="false"><span class="ui-button-text">Cancel</span></button></div></div><iframe src="javascript:''" id="FormRunner" style="position: absolute; width: 0px; height: 0px; border: medium;" tabindex="-1"></iframe></body></html>
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