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- <?xml version="1.0" encoding="UTF-8"?>
- <PurcForm><Xform><xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" xmlns:jr="http://openrosa.org/javarosa" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
- <xf:model>
- <xf:instance>
- <patient name="Patient" id="0" description-template="${/patient/family_name}$ ${/patient/middle_name}$ ${/patient/given_name}$">
- <enterer/>
- <family_name/>
- <middle_name/>
- <given_name/>
- <birth_date/>
- <birth_date_estimated/>
- <identifier/>
- <patient_id/>
- <gender/>
- <degree/>
- <family_name2/>
- <family_name_prefix/>
- <family_name_suffix/>
- <prefix/>
- <location_id>1</location_id>
- <patient_identifier_type_id/>
- <person_attribute2/>
- <person_attribute3/>
- <person_attribute5/>
- <person_attribute7/>
- <person_attribute6/>
- <person_attribute4/>
- <person_attribute1/>
- <person_address_address1/><person_address_address2/><person_address_city_village/><person_address_state_province/><person_address_postal_code/><person_address_country/><person_address_latitude/><person_address_longitude/><person_address_county_district/><person_address_neighborhood_cell/><person_address_region/><person_address_subregion/><person_address_township_division/><other_identifiers>
- <other_identifier/>
- <other_identifier_type_id/>
- <other_identifier_location_id/>
- </other_identifiers><person_attribute8/>
- <person_attribute9/>
- <person_attribute10/>
- <person_attribute11/>
- <person_attribute12/>
- <person_attribute13/>
- <person_attribute14/>
- <person_attribute15/>
- <person_attribute16/>
- <person_attribute17/>
- <person_attribute19/><person_attribute20/><person_attribute21/><person_attribute22/><person_attribute23/><person_attribute24/><person_attribute25/><person_attribute26/><person_attribute27/><person_attribute28/><person_attribute29/><person_attribute31/><person_attribute32/><person_attribute33/><person_attribute34/><person_attribute36/><person_attribute37/><person_attribute38/><person_attribute18/>
- <person_attribute35/>
- <person_attribute39/>
- <person_attribute40/>
- <person_attribute41/>
- <person_attribute42/>
- <person_attribute43/>
- <person_attribute44/>
- <person_attribute45/>
- <person_attribute46/>
- <person_attribute47/>
- <person_attribute48/>
- <person_attribute49/>
- <person_attribute50/>
- <person_attribute51/>
- <person_attribute52/>
- <person_attribute53/>
- <person_attribute54/>
- <person_attribute55/>
- <person_attribute56/>
- <person_attribute57/>
- <person_attribute58/>
- <person_attribute59/>
- <person_attribute60/>
- </patient>
- </xf:instance>
- <xf:bind id="family_name" nodeset="/patient/family_name" type="xsd:string" required="true()" constraint="length(.) <= 20" message="The length of the field is more than the required, please check"/>
- <xf:bind id="middle_name" nodeset="/patient/middle_name" type="xsd:string" constraint="length(.) <= 50" message="The length of the field is more than the required, please check"/>
- <xf:bind id="given_name" nodeset="/patient/given_name" type="xsd:string" required="true()" constraint="length(.) <= 20" message="The length of the field is more than the required, please check"/>
- <xf:bind id="birth_date" nodeset="/patient/birth_date" type="xsd:date" required="true()"/>
- <xf:bind id="birth_date_estimated" nodeset="/patient/birth_date_estimated" type="xsd:boolean"/>
- <xf:bind id="identifier" nodeset="/patient/identifier" type="xsd:string" required="true()" constraint="length(.) <= 20" message="Data out of range"/>
- <xf:bind id="patient_id" nodeset="/patient/patient_id" type="xsd:int" readonly="true()" visible="false()"/>
- <xf:bind id="gender" nodeset="/patient/gender" type="xsd:string" required="true()"/>
- <xf:bind id="degree" nodeset="/patient/degree" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="family_name2" nodeset="/patient/family_name2" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="family_name_prefix" nodeset="/patient/family_name_prefix" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="family_name_suffix" nodeset="/patient/family_name_suffix" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="prefix" nodeset="/patient/prefix" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="location_id" nodeset="/patient/location_id" type="xsd:int" readonly="true()" visible="false()"/>
- <xf:bind id="patient_identifier_type_id" nodeset="/patient/patient_identifier_type_id" type="xsd:string" required="true()"/>
- <xf:bind id="person_attribute2" nodeset="/patient/person_attribute2" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="person_attribute3" nodeset="/patient/person_attribute3" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="person_attribute5" nodeset="/patient/person_attribute5" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute7" nodeset="/patient/person_attribute7" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="person_attribute6" nodeset="/patient/person_attribute6" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="person_attribute4" nodeset="/patient/person_attribute4" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="person_attribute1" nodeset="/patient/person_attribute1" type="xsd:string" readonly="true()" visible="false()"/>
- <xf:bind id="person_address_address1" nodeset="/patient/person_address_address1" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_address2" nodeset="/patient/person_address_address2" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_city_village" nodeset="/patient/person_address_city_village" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_state_province" nodeset="/patient/person_address_state_province" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_postal_code" nodeset="/patient/person_address_postal_code" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_country" nodeset="/patient/person_address_country" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_latitude" nodeset="/patient/person_address_latitude" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_longitude" nodeset="/patient/person_address_longitude" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_county_district" nodeset="/patient/person_address_county_district" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_neighborhood_cell" nodeset="/patient/person_address_neighborhood_cell" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_region" nodeset="/patient/person_address_region" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_subregion" nodeset="/patient/person_address_subregion" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="person_address_township_division" nodeset="/patient/person_address_township_division" type="xsd:string" readonly="true()" visible="false()"/><xf:bind id="other_identifiers" nodeset="/patient/other_identifiers" readonly="true()" visible="false()"/><xf:bind id="person_attribute8" nodeset="/patient/person_attribute8" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute9" nodeset="/patient/person_attribute9" type="xsd:string" relevant="/patient/person_attribute8 = '5622'" action="enable" constraint="length(.) <= 40" message="The length of the field is more than the required, please check" required="true()"/>
- <xf:bind id="person_attribute10" nodeset="/patient/person_attribute10" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute11" nodeset="/patient/person_attribute11" type="xsd:string" relevant="/patient/person_attribute10 = '5622'" action="enable" constraint="length(.) <= 40" message="The length of the field is more than the required, please check" required="true()"/>
- <xf:bind id="person_attribute12" nodeset="/patient/person_attribute12" type="xsd:string" constraint="length(.) <= 40" message="" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute13" nodeset="/patient/person_attribute13" type="xsd:string" constraint="length(.) <= 40" message="" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute14" nodeset="/patient/person_attribute14" type="xsd:int" constraint="length(.) <= 10" message="Data out of range" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute15" nodeset="/patient/person_attribute15" type="xsd:string" constraint="length(.) <= 50" message="The length of the field is more than the required, please check" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute16" nodeset="/patient/person_attribute16" type="xsd:string" constraint="length(.) <= 50" message="The length of the field is more than the required, please check" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute17" nodeset="/patient/person_attribute17" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute19" nodeset="/patient/person_attribute19" type="xsd:date" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute20" nodeset="/patient/person_attribute20" type="xsd:int" constraint="length(.) <= 10" message="Data out of range" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute21" nodeset="/patient/person_attribute21" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute22" nodeset="/patient/person_attribute22" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute23" nodeset="/patient/person_attribute23" type="xsd:string" relevant="/patient/person_attribute22 = '1065' and patient_identifier_type_id = '3'" action="enable" constraint="length(.) <= 50" message="The length of the field is more than the required, please check" required="true()"/><xf:bind id="person_attribute24" nodeset="/patient/person_attribute24" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute25" nodeset="/patient/person_attribute25" type="xsd:string"/><xf:bind id="person_attribute26" nodeset="/patient/person_attribute26" type="xsd:int" constraint="length(.) <= 10" message="The length of the field is more than the required, please check" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute27" nodeset="/patient/person_attribute27" type="xsd:string" constraint="length(.) <= 50" message="The length of the field is more than the required, please check" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute28" nodeset="/patient/person_attribute28" type="xsd:int" constraint="length(.) <= 10" message="Data out of range" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute29" nodeset="/patient/person_attribute29" type="xsd:string" constraint="length(.) <= 12" message="The length of the field is more than the required, please check" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute31" nodeset="/patient/person_attribute31" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute32" nodeset="/patient/person_attribute32" type="xsd:int" relevant="/patient/person_attribute31 = '1065' and patient_identifier_type_id = '3'" action="enable" constraint=". >= 1 and . <= 50" message="Data out of range" required="false()"/><xf:bind id="person_attribute33" nodeset="/patient/person_attribute33" type="xsd:date" readonly="true()" visible="false()"/><xf:bind id="person_attribute34" nodeset="/patient/person_attribute34" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute36" nodeset="/patient/person_attribute36" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute37" nodeset="/patient/person_attribute37" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/><xf:bind id="person_attribute38" nodeset="/patient/person_attribute38" type="xsd:date" relevant="/patient/person_attribute37 = '161870' or /patient/person_attribute37 = '161871' or patient_identifier_type_id = '3'" action="enable" constraint=". <= today()" message="Date here is not allowed to be in the future please check" required="true()"/><xf:bind id="person_attribute18" nodeset="/patient/person_attribute18" type="xsd:string"/>
- <xf:bind id="person_attribute35" nodeset="/patient/person_attribute35" type="xsd:string"/>
- <xf:bind id="person_attribute39" nodeset="/patient/person_attribute39" type="xsd:string" relevant="/patient/person_attribute31 = '1065' and patient_identifier_type_id = '3'" action="enable" required="false()"/>
- <xf:bind id="person_attribute40" nodeset="/patient/person_attribute40" type="xsd:string" required="true()"/>
- <xf:bind id="person_attribute41" nodeset="/patient/person_attribute41" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute42" nodeset="/patient/person_attribute42" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute43" nodeset="/patient/person_attribute43" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute44" nodeset="/patient/person_attribute44" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute45" nodeset="/patient/person_attribute45" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute46" nodeset="/patient/person_attribute46" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute47" nodeset="/patient/person_attribute47" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute48" nodeset="/patient/person_attribute48" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute49" nodeset="/patient/person_attribute49" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute50" nodeset="/patient/person_attribute50" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute51" nodeset="/patient/person_attribute51" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute52" nodeset="/patient/person_attribute52" type="xsd:string" relevant="/patient/person_attribute40 != '1065' and patient_identifier_type_id != '5'" action="disable" constraint="length(.) <= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
- <xf:bind id="person_attribute53" nodeset="/patient/person_attribute53" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute54" nodeset="/patient/person_attribute54" type="xsd:boolean" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute55" nodeset="/patient/person_attribute55" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute56" nodeset="/patient/person_attribute56" type="xsd:string" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute57" nodeset="/patient/person_attribute57" type="xsd:boolean" relevant="patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute58" nodeset="/patient/person_attribute58" type="xsd:string" relevant="/patient/person_attribute57 = true and patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute59" nodeset="/patient/person_attribute59" type="xsd:string" relevant="/patient/person_attribute58 = '162049' and patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="person_attribute60" nodeset="/patient/person_attribute60" type="xsd:string" relevant="/patient/person_attribute37 = '161940' and patient_identifier_type_id = '3'" action="enable" required="true()"/>
- <xf:bind id="other_identifier" nodeset="/patient/other_identifiers/other_identifier" type="xsd:string"/>
- <xf:bind id="other_identifier_type_id" nodeset="/patient/other_identifiers/other_identifier_type_id" type="xsd:string" constraint="length(.) <= 20" message=""/>
- <xf:bind id="other_identifier_location_id" nodeset="/patient/other_identifiers/other_identifier_location_id" type="xsd:string" constraint="length(.) <= 12" message=""/>
- </xf:model>
- <xf:group id="1">
- <xf:label>Page1</xf:label>
- <xf:input bind="family_name">
- <xf:label>Last Name</xf:label>
- <xf:hint>The patient family name</xf:hint>
- </xf:input>
- <xf:input bind="middle_name">
- <xf:label>Middle name</xf:label>
- <xf:hint>The patient middle name</xf:hint>
- </xf:input>
- <xf:input bind="given_name">
- <xf:label>First Name</xf:label>
- <xf:hint>The patient given name</xf:hint>
- </xf:input>
- <xf:input bind="birth_date">
- <xf:label>Date of birth</xf:label>
- <xf:hint>The patient birth date</xf:hint>
- </xf:input>
- <xf:input bind="birth_date_estimated">
- <xf:label>Birth Date Estimated</xf:label>
- <xf:hint>Is the patient birth date estimated?</xf:hint>
- </xf:input>
- <xf:input bind="identifier">
- <xf:label>NACP number</xf:label>
- <xf:hint>The patient identifier</xf:hint>
- </xf:input>
- <xf:input bind="patient_id">
- <xf:label>Patient ID</xf:label>
- <xf:hint>The patient ID</xf:hint>
- </xf:input>
- <xf:select1 bind="gender">
- <xf:label>Gender</xf:label>
- <xf:hint>The patient's sex</xf:hint>
- <xf:item id="M">
- <xf:label>Male</xf:label>
- <xf:value>M</xf:value>
- </xf:item>
- <xf:item id="F">
- <xf:label>Female</xf:label>
- <xf:value>F</xf:value>
- </xf:item>
- </xf:select1>
- <xf:input bind="degree">
- <xf:label>Degree</xf:label>
- <xf:hint>The patient name degree</xf:hint>
- </xf:input>
- <xf:input bind="family_name2">
- <xf:label>Family Name 2</xf:label>
- <xf:hint>The patient second family name</xf:hint>
- </xf:input>
- <xf:input bind="family_name_prefix">
- <xf:label>Family Name Prefix</xf:label>
- <xf:hint>The patient family name prefix</xf:hint>
- </xf:input>
- <xf:input bind="family_name_suffix">
- <xf:label>Family Name Suffix</xf:label>
- <xf:hint>The patient family name suffix</xf:hint>
- </xf:input>
- <xf:input bind="prefix">
- <xf:label>Prefix</xf:label>
- <xf:hint>The patient name prefix</xf:hint>
- </xf:input>
- <xf:input bind="location_id">
- <xf:label>Location</xf:label>
- <xf:hint>The patient's location</xf:hint>
- </xf:input>
- <xf:select1 bind="patient_identifier_type_id">
- <xf:label>Identifier Type</xf:label>
- <xf:hint>The patient's identifier type</xf:hint>
- <xf:item id="2">
- <xf:label>Old Identification Number</xf:label>
- <xf:value>2</xf:value>
- </xf:item><xf:item id="1">
- <xf:label>OpenMRS Identification Number</xf:label>
- <xf:value>1</xf:value>
- </xf:item><xf:item id="3">
- <xf:label>NACPNO</xf:label>
- <xf:value>3</xf:value>
- </xf:item><xf:item id="5">
- <xf:label>HEI Number</xf:label>
- <xf:value>5</xf:value>
- </xf:item>
- <xf:item id="4">
- <xf:label>OpenEMPI ID</xf:label>
- <xf:value>4</xf:value>
- </xf:item>
- </xf:select1>
- <xf:input bind="person_attribute2">
- <xf:label>Birthplace</xf:label>
- <xf:hint>Location of persons birth</xf:hint>
- </xf:input>
- <xf:input bind="person_attribute3">
- <xf:label>Citizenship</xf:label>
- <xf:hint>Country of which this person is a member</xf:hint>
- </xf:input>
- <xf:select1 bind="person_attribute5">
- <xf:label>Civil Status</xf:label>
- <xf:hint>Marriage status of this person</xf:hint>
- <xf:item concept_id="1056" id="1056">
- <xf:label>SEPARATED</xf:label>
- <xf:value>1056</xf:value>
- </xf:item>
- <xf:item concept_id="1057" id="1057">
- <xf:label>NEVER MARRIED</xf:label>
- <xf:value>1057</xf:value>
- </xf:item>
- <xf:item concept_id="1058" id="1058">
- <xf:label>DIVORCED</xf:label>
- <xf:value>1058</xf:value>
- </xf:item>
- <xf:item concept_id="1059" id="1059">
- <xf:label>WIDOWED</xf:label>
- <xf:value>1059</xf:value>
- </xf:item>
- <xf:item concept_id="1060" id="1060">
- <xf:label>LIVING WITH PARTNER</xf:label>
- <xf:value>1060</xf:value>
- </xf:item>
- <xf:item concept_id="5555" id="5555">
- <xf:label>MARRIED</xf:label>
- <xf:value>5555</xf:value>
- </xf:item>
- <xf:item concept_id="5622" id="5622">
- <xf:label>OTHER NON-CODED</xf:label>
- <xf:value>5622</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="person_attribute7">
- <xf:label>Health Center</xf:label>
- <xf:hint>Specific Location of this person's home health center.</xf:hint>
- <xf:item id="1">
- <xf:label>Unknown Location [1]</xf:label>
- <xf:value>1</xf:value>
- </xf:item>
- </xf:select1>
- <xf:input bind="person_attribute6">
- <xf:label>Health District</xf:label>
- <xf:hint>District/region in which this patient' home health center resides</xf:hint>
- </xf:input>
- <xf:input bind="person_attribute4">
- <xf:label>Mother's Name</xf:label>
- <xf:hint>First or last name of this person's mother</xf:hint>
- </xf:input>
- <xf:input bind="person_attribute1">
- <xf:label>Race</xf:label>
- <xf:hint>Group of persons related by common descent or heredity</xf:hint>
- </xf:input>
- <xf:input bind="person_address_address1">
- <xf:label>Address 1</xf:label>
- </xf:input><xf:input bind="person_address_address2">
- <xf:label>Address 2</xf:label>
- </xf:input><xf:input bind="person_address_city_village">
- <xf:label>City/Village</xf:label>
- </xf:input><xf:input bind="person_address_state_province">
- <xf:label>State/Province</xf:label>
- </xf:input><xf:input bind="person_address_postal_code">
- <xf:label>Postal Code</xf:label>
- </xf:input><xf:input bind="person_address_country">
- <xf:label>Country</xf:label>
- </xf:input><xf:input bind="person_address_latitude">
- <xf:label>Latitude</xf:label>
- </xf:input><xf:input bind="person_address_longitude">
- <xf:label>Longitude</xf:label>
- </xf:input><xf:input bind="person_address_county_district">
- <xf:label>County/District</xf:label>
- </xf:input><xf:input bind="person_address_neighborhood_cell">
- <xf:label>Neighborhood Cell</xf:label>
- </xf:input><xf:input bind="person_address_region">
- <xf:label>Region</xf:label>
- </xf:input><xf:input bind="person_address_subregion">
- <xf:label>Sub Region</xf:label>
- </xf:input><xf:input bind="person_address_township_division">
- <xf:label>Township/Division</xf:label>
- </xf:input><xf:group id="other_identifiers">
- <xf:label>Other dentifiers</xf:label>
- <xf:repeat bind="other_identifiers">
- <xf:input bind="other_identifier">
- <xf:label>Identifier</xf:label>
- <xf:hint>The patient's other identifier value</xf:hint>
- </xf:input>
- <xf:select1 bind="other_identifier_type_id">
- <xf:label>Identifier Type</xf:label>
- <xf:hint>The patient's other identifier type</xf:hint>
- <xf:item id="2">
- <xf:label>Old Identification Number</xf:label>
- <xf:value>2</xf:value>
- </xf:item><xf:item id="1">
- <xf:label>OpenMRS Identification Number</xf:label>
- <xf:value>1</xf:value>
- </xf:item><xf:item id="3">
- <xf:label>NACPNO</xf:label>
- <xf:value>3</xf:value>
- </xf:item><xf:item id="5">
- <xf:label>HEI Number</xf:label>
- <xf:value>5</xf:value>
- </xf:item>
- <xf:item id="4">
- <xf:label>OpenEMPI ID</xf:label>
- <xf:value>4</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="other_identifier_location_id">
- <xf:label>Identifier Location</xf:label>
- <xf:hint>The patient's other identifier location</xf:hint>
- <xf:item id="1">
- <xf:label>Unknown Location [1]</xf:label>
- <xf:value>1</xf:value>
- </xf:item>
- </xf:select1>
- </xf:repeat>
- </xf:group><xf:select1 bind="person_attribute8">
- <xf:label>District</xf:label>
- <xf:hint>this is the residence of the patient (district)</xf:hint>
- <xf:item concept_id="161002" id="161002">
- <xf:label>KILOMBERO</xf:label>
- <xf:value>161002</xf:value>
- </xf:item>
- <xf:item concept_id="161003" id="161003">
- <xf:label>KILOSA</xf:label>
- <xf:value>161003</xf:value>
- </xf:item>
- <xf:item concept_id="161004" id="161004">
- <xf:label>ULANGA</xf:label>
- <xf:value>161004</xf:value>
- </xf:item>
- <xf:item concept_id="5622" id="5622">
- <xf:label>OTHER NON-CODED</xf:label>
- <xf:value>5622</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="person_attribute9">
- <xf:label>Other distict(please specify)</xf:label>
- <xf:hint>other unspecified district</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute10">
- <xf:label>Ward</xf:label>
- <xf:hint>residence of the patient(ward)</xf:hint>
- <xf:item concept_id="161005" id="161005">
- <xf:label>IDETE</xf:label>
- <xf:value>161005</xf:value>
- </xf:item>
- <xf:item concept_id="161006" id="161006">
- <xf:label>IFAKARA</xf:label>
- <xf:value>161006</xf:value>
- </xf:item>
- <xf:item concept_id="161007" id="161007">
- <xf:label>KIBAONI</xf:label>
- <xf:value>161007</xf:value>
- </xf:item>
- <xf:item concept_id="161008" id="161008">
- <xf:label>KIBEREGE</xf:label>
- <xf:value>161008</xf:value>
- </xf:item>
- <xf:item concept_id="161009" id="161009">
- <xf:label>KIDATU</xf:label>
- <xf:value>161009</xf:value>
- </xf:item>
- <xf:item concept_id="161010" id="161010">
- <xf:label>LUMEMO</xf:label>
- <xf:value>161010</xf:value>
- </xf:item>
- <xf:item concept_id="161011" id="161011">
- <xf:label>LUPIRO</xf:label>
- <xf:value>161011</xf:value>
- </xf:item>
- <xf:item concept_id="161012" id="161012">
- <xf:label>MANG'ULA</xf:label>
- <xf:value>161012</xf:value>
- </xf:item>
- <xf:item concept_id="161014" id="161014">
- <xf:label>MLIMBA</xf:label>
- <xf:value>161014</xf:value>
- </xf:item>
- <xf:item concept_id="161015" id="161015">
- <xf:label>MNGETA</xf:label>
- <xf:value>161015</xf:value>
- </xf:item>
- <xf:item concept_id="5622" id="5622">
- <xf:label>OTHER NON-CODED</xf:label>
- <xf:value>5622</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="person_attribute11">
- <xf:label>Other ward(please specify)</xf:label>
- <xf:hint>Other ward unspecified</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute12">
- <xf:label>Village</xf:label>
- <xf:hint>residence of this patient(village)</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute13">
- <xf:label>Street</xf:label>
- <xf:hint>residence of this patient(Street)</xf:hint>
- </xf:select1>
- <xf:input bind="person_attribute14">
- <xf:label>Telephone number</xf:label>
- <xf:hint>telephone number of the patient</xf:hint>
- </xf:input>
- <xf:select1 bind="person_attribute15">
- <xf:label>10CELL_LEADER</xf:label>
- <xf:hint>10 cell leader name</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute16">
- <xf:label>HEADD_HOUSEHOLD</xf:label>
- <xf:hint>Head household of the patient</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute17">
- <xf:label>EDUCATION</xf:label>
- <xf:hint>highest education level of the patient</xf:hint>
- <xf:item concept_id="1107" id="1107">
- <xf:label>NONE</xf:label>
- <xf:value>1107</xf:value>
- </xf:item>
- <xf:item concept_id="1713" id="1713">
- <xf:label>PRIMARY SCHOOL EDUCATION</xf:label>
- <xf:value>1713</xf:value>
- </xf:item>
- <xf:item concept_id="1714" id="1714">
- <xf:label>SECONDARY SCHOOL EDUCATION</xf:label>
- <xf:value>1714</xf:value>
- </xf:item>
- <xf:item concept_id="159785" id="159785">
- <xf:label>college/university/polytechnic</xf:label>
- <xf:value>159785</xf:value>
- </xf:item>
- <xf:item concept_id="5622" id="5622">
- <xf:label>OTHER NON-CODED</xf:label>
- <xf:value>5622</xf:value>
- </xf:item>
- </xf:select1>
- <xf:input bind="person_attribute19">
- <xf:label>DATE_FIRST_POS</xf:label>
- <xf:hint>Date of first positive HIV test</xf:hint>
- </xf:input><xf:input bind="person_attribute20">
- <xf:label>VCT_NO</xf:label>
- <xf:hint>VCT number</xf:hint>
- </xf:input><xf:select1 bind="person_attribute21">
- <xf:label>HIVTYPE</xf:label>
- <xf:hint>HIV type</xf:hint>
- <xf:item concept_id="161017" id="161017">
- <xf:label>HIV type I</xf:label>
- <xf:value>161017</xf:value>
- </xf:item>
- <xf:item concept_id="161018" id="161018">
- <xf:label>HIV type II</xf:label>
- <xf:value>161018</xf:value>
- </xf:item>
- <xf:item concept_id="161019" id="161019">
- <xf:label>Both</xf:label>
- <xf:value>161019</xf:value>
- </xf:item>
- <xf:item concept_id="1067" id="1067">
- <xf:label>UNKNOWN</xf:label>
- <xf:value>1067</xf:value>
- </xf:item>
- </xf:select1><xf:select1 bind="person_attribute22">
- <xf:label>COMM_SUPPORT</xf:label>
- <xf:hint>community support</xf:hint>
- <xf:item concept_id="1065" id="1065">
- <xf:label>YES</xf:label>
- <xf:value>1065</xf:value>
- </xf:item>
- <xf:item concept_id="1066" id="1066">
- <xf:label>NO</xf:label>
- <xf:value>1066</xf:value>
- </xf:item>
- </xf:select1><xf:select1 bind="person_attribute23">
- <xf:label>SUPPORT_GROUP</xf:label>
- <xf:hint>support group</xf:hint>
- </xf:select1><xf:select bind="person_attribute24">
- <xf:label>PAT_REF</xf:label>
- <xf:hint>patient referral source</xf:hint>
- <xf:item concept_id="160542" id="160542">
- <xf:label>Outpatient department</xf:label>
- <xf:value>160542</xf:value>
- </xf:item>
- <xf:item concept_id="161020" id="161020">
- <xf:label>PLHIV group</xf:label>
- <xf:value>161020</xf:value>
- </xf:item>
- <xf:item concept_id="160546" id="160546">
- <xf:label>Sexually transmitted infection program/clinic</xf:label>
- <xf:value>160546</xf:value>
- </xf:item>
- <xf:item concept_id="161039" id="161039">
- <xf:label>HBC</xf:label>
- <xf:value>161039</xf:value>
- </xf:item><xf:item concept_id="161021" id="161021">
- <xf:label>RCH/PMTCT/EID</xf:label>
- <xf:value>161021</xf:value>
- </xf:item><xf:item concept_id="5485" id="5485">
- <xf:label>Inpatient</xf:label>
- <xf:value>5485</xf:value>
- </xf:item><xf:item concept_id="5487" id="5487">
- <xf:label>Tuberculosis Treatment or DOT Program</xf:label>
- <xf:value>5487</xf:value>
- </xf:item><xf:item concept_id="160539" id="160539">
- <xf:label>Voluntary counseling and testing program</xf:label>
- <xf:value>160539</xf:value>
- </xf:item><xf:item concept_id="5622" id="5622">
- <xf:label>OTHER NON-CODED</xf:label>
- <xf:value>5622</xf:value>
- </xf:item><xf:item concept_id="160551" id="160551^Self referral and VCT^99DCT">
- <xf:label>Self referral and VCT</xf:label>
- <xf:value>160551^Self referral and VCT^99DCT</xf:value>
- </xf:item>
- </xf:select><xf:select1 bind="person_attribute25">
- <xf:label>OTHER_PATREF</xf:label>
- <xf:hint>Other source of referral not specified</xf:hint>
- </xf:select1><xf:input bind="person_attribute26">
- <xf:label>TELNO_HH</xf:label>
- <xf:hint>telephone number of head household of the patient</xf:hint>
- </xf:input><xf:select1 bind="person_attribute27">
- <xf:label>TXT_SUPPORTER</xf:label>
- <xf:hint>Name of treatment support of this patient</xf:hint>
- </xf:select1><xf:input bind="person_attribute28">
- <xf:label>TELNO_TXTSUPP</xf:label>
- <xf:hint>telephone number of treatment supporter of this patient</xf:hint>
- </xf:input><xf:select1 bind="person_attribute29">
- <xf:label>DSS_NO</xf:label>
- <xf:hint>DSS number</xf:hint>
- </xf:select1><xf:select1 bind="person_attribute31">
- <xf:label>CHILDREN</xf:label>
- <xf:hint>This patient has children?</xf:hint>
- <xf:item concept_id="1065" id="1065">
- <xf:label>YES</xf:label>
- <xf:value>1065</xf:value>
- </xf:item>
- <xf:item concept_id="1066" id="1066">
- <xf:label>NO</xf:label>
- <xf:value>1066</xf:value>
- </xf:item>
- </xf:select1><xf:input bind="person_attribute32">
- <xf:label>NO_CHILD</xf:label>
- <xf:hint>number of children</xf:hint>
- </xf:input><xf:input bind="person_attribute33">
- <xf:label>DOB_LAST_CHILD</xf:label>
- <xf:hint>Date of birth of the last children</xf:hint>
- </xf:input><xf:select1 bind="person_attribute34">
- <xf:label>OCCUPATION</xf:label>
- <xf:hint>Occupation of this patient</xf:hint>
- <xf:item concept_id="1538" id="1538">
- <xf:label>FARMER</xf:label>
- <xf:value>1538</xf:value>
- </xf:item>
- <xf:item concept_id="159465" id="159465">
- <xf:label>Student</xf:label>
- <xf:value>159465</xf:value>
- </xf:item>
- <xf:item concept_id="161457" id="161457">
- <xf:label>Employee-private</xf:label>
- <xf:value>161457</xf:value>
- </xf:item>
- <xf:item concept_id="161013" id="161013">
- <xf:label>Employee-government</xf:label>
- <xf:value>161013</xf:value>
- </xf:item>
- <xf:item concept_id="161016" id="161016">
- <xf:label>self-employed</xf:label>
- <xf:value>161016</xf:value>
- </xf:item>
- <xf:item concept_id="123801" id="123801">
- <xf:label>Unemployed</xf:label>
- <xf:value>123801</xf:value>
- </xf:item>
- <xf:item concept_id="160295" id="160295">
- <xf:label>Housewife</xf:label>
- <xf:value>160295</xf:value>
- </xf:item>
- <xf:item concept_id="159461" id="159461">
- <xf:label>Retired</xf:label>
- <xf:value>159461</xf:value>
- </xf:item>
- <xf:item concept_id="5622" id="5622">
- <xf:label>OTHER NON-CODED</xf:label>
- <xf:value>5622</xf:value>
- </xf:item>
- </xf:select1><xf:select bind="person_attribute36">
- <xf:label>TRANSFER_IN</xf:label>
- <xf:hint>Transfer in(select all that apply)</xf:hint>
- <xf:item concept_id="1175" id="1175">
- <xf:label>NOT APPLICABLE</xf:label>
- <xf:value>1175</xf:value>
- </xf:item>
- <xf:item concept_id="161049" id="161049">
- <xf:label>with records(referral and CTC 1 forms)</xf:label>
- <xf:value>161049</xf:value>
- </xf:item>
- <xf:item concept_id="161050" id="161050">
- <xf:label>No records available</xf:label>
- <xf:value>161050</xf:value>
- </xf:item>
- <xf:item concept_id="161051" id="161051">
- <xf:label>In care</xf:label>
- <xf:value>161051</xf:value>
- </xf:item>
- <xf:item concept_id="161052" id="161052">
- <xf:label>On ART</xf:label>
- <xf:value>161052</xf:value>
- </xf:item>
- </xf:select><xf:select1 bind="person_attribute37">
- <xf:label>CONSENT</xf:label>
- <xf:hint>informed consent patient signed</xf:hint>
- <xf:item concept_id="161053" id="161053">
- <xf:label>No. but ask again later</xf:label>
- <xf:value>161053</xf:value>
- </xf:item>
- <xf:item concept_id="161054" id="161054">
- <xf:label>No, the patient refused</xf:label>
- <xf:value>161054</xf:value>
- </xf:item>
- <xf:item concept_id="161869" id="161869">
- <xf:label>Form given to take home</xf:label>
- <xf:value>161869</xf:value>
- </xf:item>
- <xf:item concept_id="161870" id="161870">
- <xf:label>Yes, given today</xf:label>
- <xf:value>161870</xf:value>
- </xf:item>
- <xf:item concept_id="161871" id="161871">
- <xf:label>Yes, and consent use of data since baseline</xf:label>
- <xf:value>161871</xf:value>
- </xf:item>
- <xf:item concept_id="161939" id="161939">
- <xf:label>No, Patient too sick to be asked</xf:label>
- <xf:value>161939</xf:value>
- </xf:item>
- <xf:item concept_id="161940" id="161940">
- <xf:label>Not signed for other reason</xf:label>
- <xf:value>161940</xf:value>
- </xf:item>
- </xf:select1><xf:input bind="person_attribute38">
- <xf:label>DATE_CONSENT</xf:label>
- <xf:hint>Date of informed consent</xf:hint>
- </xf:input><xf:select1 bind="person_attribute18">
- <xf:label>EDU_OTHER</xf:label>
- <xf:hint>Other education level</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute35">
- <xf:label>OCCUP_OTHER</xf:label>
- <xf:hint>Occupation of this patient</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute39">
- <xf:label>CHILDREN_LESS16</xf:label>
- <xf:hint>Any children who are <16 years of age</xf:hint>
- <xf:item concept_id="1066" id="1066">
- <xf:label>NO</xf:label>
- <xf:value>1066</xf:value>
- </xf:item>
- <xf:item concept_id="1065" id="1065">
- <xf:label>YES</xf:label>
- <xf:value>1065</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="person_attribute40">
- <xf:label>FAMILY_CDCI</xf:label>
- <xf:hint>Any family members attending CDCI?</xf:hint>
- <xf:item concept_id="1066" id="1066">
- <xf:label>NO</xf:label>
- <xf:value>1066</xf:value>
- </xf:item>
- <xf:item concept_id="1065" id="1065">
- <xf:label>YES</xf:label>
- <xf:value>1065</xf:value>
- </xf:item>
- <xf:item concept_id="1067" id="1067">
- <xf:label>UNKNOWN</xf:label>
- <xf:value>1067</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="person_attribute41">
- <xf:label>FAMILY_NAME1</xf:label>
- <xf:hint>Name of 1st family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute42">
- <xf:label>FAMILY_RELATION1</xf:label>
- <xf:hint>Relationship of 1st family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute43">
- <xf:label>FAMILY_NACP1</xf:label>
- <xf:hint>NACPNO for 1st family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute44">
- <xf:label>FAMILY_NAME2</xf:label>
- <xf:hint>Name of 2nd family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute45">
- <xf:label>FAMILY_RELATION2</xf:label>
- <xf:hint>Relationship of 2ND family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute46">
- <xf:label>FAMILY_NACP2</xf:label>
- <xf:hint>NACPNO for 2ND family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute47">
- <xf:label>FAMILY_NAME3</xf:label>
- <xf:hint>Name of 3RD family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute48">
- <xf:label>FAMILY_RELATION3</xf:label>
- <xf:hint>Relationship of 3RD family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute49">
- <xf:label>FAMILY_NACP3</xf:label>
- <xf:hint>NACPNO for 3RD family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute50">
- <xf:label>FAMILY_NAME4</xf:label>
- <xf:hint>Name of 4TH family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute51">
- <xf:label>FAMILY_RELATION4</xf:label>
- <xf:hint>Relationship of 4TH family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute52">
- <xf:label>FAMILY_NACP4</xf:label>
- <xf:hint>NACPNO for 4TH family member</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute53">
- <xf:label>NICK_NAME</xf:label>
- <xf:hint>A well known name of a client</xf:hint>
- </xf:select1>
- <xf:input bind="person_attribute54">
- <xf:label>Birth Date Estimated</xf:label>
- <xf:hint>Is the patient birth date estimated?</xf:hint>
- </xf:input>
- <xf:select1 bind="person_attribute55">
- <xf:label>TB_NO</xf:label>
- <xf:hint>Unique identification number of tb patient</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute56">
- <xf:label>CBHS_NO</xf:label>
- <xf:hint>CBHS number</xf:hint>
- </xf:select1>
- <xf:input bind="person_attribute57">
- <xf:label>HEALTH_INSURANCE</xf:label>
- <xf:hint>Do you have health insurance?</xf:hint>
- </xf:input>
- <xf:select1 bind="person_attribute58">
- <xf:label>HEALTH_INSURANCE_TYPE</xf:label>
- <xf:hint>Type of health insurance scheme</xf:hint>
- <xf:item concept_id="162044" id="162044">
- <xf:label>NHIF</xf:label>
- <xf:value>162044</xf:value>
- </xf:item>
- <xf:item concept_id="162045" id="162045">
- <xf:label>SHIB_NSSF</xf:label>
- <xf:value>162045</xf:value>
- </xf:item>
- <xf:item concept_id="162046" id="162046">
- <xf:label>CHF</xf:label>
- <xf:value>162046</xf:value>
- </xf:item>
- <xf:item concept_id="162047" id="162047">
- <xf:label>TIKA</xf:label>
- <xf:value>162047</xf:value>
- </xf:item>
- <xf:item concept_id="162048" id="162048">
- <xf:label>AAR</xf:label>
- <xf:value>162048</xf:value>
- </xf:item>
- <xf:item concept_id="162049" id="162049">
- <xf:label>OTHER_HEALTH_INSURANCE</xf:label>
- <xf:value>162049</xf:value>
- </xf:item>
- </xf:select1>
- <xf:select1 bind="person_attribute59">
- <xf:label>OTHER_HEALTH_INSURANCE_SPECIFY</xf:label>
- <xf:hint>Other health insurance specify</xf:hint>
- </xf:select1>
- <xf:select1 bind="person_attribute60">
- <xf:label>CONSENT_OTHER</xf:label>
- <xf:hint>Other reasons for not signing consent form</xf:hint>
- </xf:select1>
- </xf:group>
- </xf:xforms></Xform><Layout><Form id="0"><Page Text="Page1" fontWeight="normal" fontSize="12px" fontFamily="Verdana, 'Lucida Grande', 'Trebuchet MS', Arial, Sans-Serif" Binding="Page1" Width="900px" Height="2500px" backgroundColor=""><Item WidgetType="Label" Text="Registration Form" HelpText="Label" Binding="LEFT34pxTOP60px" Left="48px" Top="30px" Height="31px" TabIndex="0" fontWeight="bolder" fontSize="20px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" borderStyle="solid" borderWidth="1px"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP249px" Left="78px" Top="652px" Width="820px" Height="0px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Button" Text="Cancel" HelpText="cancel" Binding="cancel" Left="793px" Top="2468px" Width="70px" Height="30px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Button" Text="Submit" HelpText="submit" Binding="submit" Left="705px" Top="2466px" Width="70px" Height="32px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" Id="submit"/><Item WidgetType="GroupBox" Binding="LEFT48pxTOP100px" Left="42px" Top="101px" Width="820px" Height="2355px" TabIndex="0" fontWeight="normal" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" borderStyle="solid"><Item WidgetType="Label" Text="PATIENT INFORMATION" HelpText="Header Label" Binding="LEFT48pxTOP100px" Left="0px" Top="0px" Width="100%" Height="20px" TabIndex="0" color="white" fontWeight="bold" fontSize="16px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="rgb(26, 172, 155)" textAlign="center" HeaderLabel="true"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute34" Left="465px" Top="848px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Retired" HelpText="Retired" Binding="159461" ParentBinding="person_attribute34" Left="328px" Top="849px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Housewife" HelpText="Housewife" Binding="160295" ParentBinding="person_attribute34" Left="225px" Top="848px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Unemployed" HelpText="Unemployed" Binding="123801" ParentBinding="person_attribute34" Left="106px" Top="849px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Farmer" HelpText="FARMER" Binding="1538" ParentBinding="person_attribute34" Left="106px" Top="819px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Student" HelpText="Student" Binding="159465" ParentBinding="person_attribute34" Left="225px" Top="819px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Employee-private" HelpText="Employee-private" Binding="161457" ParentBinding="person_attribute34" Left="329px" Top="818px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Employee-government" HelpText="Employee-government" Binding="161013" ParentBinding="person_attribute34" Left="465px" Top="819px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="College/University" HelpText="college/university/polytechnic" Binding="159785" ParentBinding="person_attribute17" Left="225px" Top="918px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Primary school education" HelpText="PRIMARY SCHOOL EDUCATION" Binding="1713" ParentBinding="person_attribute17" Left="325px" Top="882px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="None" HelpText="NONE" Binding="1107" ParentBinding="person_attribute17" Left="225px" Top="882px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Self-employed" HelpText="self-employed" Binding="161016" ParentBinding="person_attribute34" Left="672px" Top="821px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Secondary school education" HelpText="SECONDARY SCHOOL EDUCATION" Binding="1714" ParentBinding="person_attribute17" Left="523px" Top="883px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="telephone number of treatment supporter of this patient" Binding="person_attribute28" Left="646px" Top="515px" Width="159px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Mngeta" HelpText="MNGETA" Binding="161015" ParentBinding="person_attribute10" Left="370px" Top="316px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Mlimba" HelpText="MLIMBA" Binding="161014" ParentBinding="person_attribute10" Left="270px" Top="316px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kibaoni" HelpText="KIBAONI" Binding="161007" ParentBinding="person_attribute10" Left="270px" Top="287px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Mang'ula" HelpText="MANG'ULA" Binding="161012" ParentBinding="person_attribute10" Left="170px" Top="314px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Ifakara" HelpText="IFAKARA" Binding="161006" ParentBinding="person_attribute10" Left="170px" Top="287px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Lupiro" HelpText="LUPIRO" Binding="161011" ParentBinding="person_attribute10" Left="70px" Top="317px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Idete" HelpText="IDETE" Binding="161005" ParentBinding="person_attribute10" Left="70px" Top="289px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute8" Left="371px" Top="240px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Ulanga" HelpText="ULANGA" Binding="161004" ParentBinding="person_attribute8" Left="271px" Top="241px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kilosa" HelpText="KILOSA" Binding="161003" ParentBinding="person_attribute8" Left="171px" Top="239px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kilombero" HelpText="KILOMBERO" Binding="161002" ParentBinding="person_attribute8" Left="71px" Top="239px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Last name" HelpText="The patient family name" Binding="family_name" Left="576px" Top="119px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute40" Left="323px" Top="1838px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute40" Left="275px" Top="1838px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 1st family member" HelpText="Relationship of 1st family member" Binding="person_attribute42" Left="21px" Top="1930px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 1st family member" HelpText="NACPNO for 1st family member" Binding="person_attribute43" Left="19px" Top="1968px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 2nd family member" HelpText="Name of 2nd family member" Binding="person_attribute44" Left="19px" Top="2007px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 2nd family member" HelpText="Relationship of 2ND family member" Binding="person_attribute45" Left="19px" Top="2049px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 2nd family member" HelpText="NACPNO for 2ND family member" Binding="person_attribute46" Left="19px" Top="2086px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 3rd family member" HelpText="Name of 3RD family member" Binding="person_attribute47" Left="19px" Top="2129px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 3rd family member" HelpText="Relationship of 3RD family member" Binding="person_attribute48" Left="19px" Top="2170px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 3rd family member" HelpText="NACPNO for 3RD family member" Binding="person_attribute49" Left="20px" Top="2211px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 4th family member" HelpText="Name of 4TH family member" Binding="person_attribute50" Left="19px" Top="2251px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 4th family member" HelpText="Relationship of 4TH family member" Binding="person_attribute51" Left="19px" Top="2286px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No, Patient too sick to be asked" HelpText="No, Patient too sick to be asked" Binding="161939" ParentBinding="person_attribute37" Left="150px" Top="1710px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="On ART" HelpText="On ART" Binding="161052" ParentBinding="person_attribute36" Left="706px" Top="1598px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="Not applicable" HelpText="NOT APPLICABLE" Binding="1175" ParentBinding="person_attribute36" Left="236px" Top="1595px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="No records available" HelpText="No records available" Binding="161050" ParentBinding="person_attribute36" Left="528px" Top="1596px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="In care" HelpText="In care" Binding="161051" ParentBinding="person_attribute36" Left="529px" Top="1635px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="PLHIV group" HelpText="PLHIV group" Binding="161020" ParentBinding="person_attribute24" Left="258px" Top="1505px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="HBC" HelpText="HBC" Binding="161039" ParentBinding="person_attribute24" Left="258px" Top="1445px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="RCH/PMTCT/EID" HelpText="RCH/PMTCT/EID" Binding="161021" ParentBinding="person_attribute24" Left="478px" Top="1475px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="STI program/clinic" HelpText="Sexually transmitted infection program/clinic" Binding="160546" ParentBinding="person_attribute24" Left="478px" Top="1445px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="OPD" HelpText="Outpatient department" Binding="160542" ParentBinding="person_attribute24" Left="258px" Top="1420px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="TB or DOT Program" HelpText="Tuberculosis Treatment or DOT Program" Binding="5487" ParentBinding="person_attribute24" Left="478px" Top="1420px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Both" HelpText="Both" Binding="161019" ParentBinding="person_attribute21" Left="462px" Top="1226px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="HIV type II" HelpText="HIV type II" Binding="161018" ParentBinding="person_attribute21" Left="322px" Top="1225px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="HIV type I" HelpText="HIV type I" Binding="161017" ParentBinding="person_attribute21" Left="222px" Top="1225px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Separated" HelpText="SEPARATED" Binding="1056" ParentBinding="person_attribute5" Left="571px" Top="679px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Living with partner" HelpText="LIVING WITH PARTNER" Binding="1060" ParentBinding="person_attribute5" Left="401px" Top="679px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Widowed" HelpText="WIDOWED" Binding="1059" ParentBinding="person_attribute5" Left="301px" Top="709px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Married" HelpText="MARRIED" Binding="5555" ParentBinding="person_attribute5" Left="301px" Top="679px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Divorced" HelpText="DIVORCED" Binding="1058" ParentBinding="person_attribute5" Left="171px" Top="709px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Never married" HelpText="NEVER MARRIED" Binding="1057" ParentBinding="person_attribute5" Left="170px" Top="679px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="DatePicker" HelpText="The patient birth date" Binding="birth_date" Left="240px" Top="638px" Width="167px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="National Health Insurance Fund (NHIF)" HelpText="NHIF" Binding="162044" ParentBinding="person_attribute58" Left="256px" Top="1005px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Community Health Fund (CHF)" HelpText="CHF" Binding="162046" ParentBinding="person_attribute58" Left="576px" Top="1047px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Tiba Kwa Kadi (TIKA)" HelpText="TIKA" Binding="162047" ParentBinding="person_attribute58" Left="575px" Top="1006px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="NSSF Social Health Insurance Benefit (SHIB)" HelpText="SHIB_NSSF" Binding="162045" ParentBinding="person_attribute58" Left="255px" Top="1045px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other Health Insurance" HelpText="OTHER_HEALTH_INSURANCE" Binding="162049" ParentBinding="person_attribute58" Left="255px" Top="1086px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="AAR" HelpText="AAR" Binding="162048" ParentBinding="person_attribute58" Left="576px" Top="1086px" TabIndex="0" fontWeight="normal" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="Yes" Binding="true" ParentBinding="person_attribute57" Left="266px" Top="964px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="No" Binding="false" ParentBinding="person_attribute57" Left="348px" Top="965px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute22" Left="453px" Top="1288px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute22" Left="535px" Top="1289px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="Yes" Binding="true" ParentBinding="person_attribute54" Left="481px" Top="643px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="No" Binding="false" ParentBinding="person_attribute54" Left="567px" Top="644px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Female" HelpText="Female" Binding="F" ParentBinding="gender" Left="732px" Top="644px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Male" HelpText="Male" Binding="M" ParentBinding="gender" Left="665px" Top="645px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 1st family member" Binding="person_attribute43" Left="255px" Top="1958px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 2nd family member" Binding="person_attribute44" Left="255px" Top="1998px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 2ND family member" Binding="person_attribute45" Left="255px" Top="2038px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 2ND family member" Binding="person_attribute46" Left="256px" Top="2079px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 3RD family member" Binding="person_attribute47" Left="255px" Top="2118px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 3RD family member" Binding="person_attribute48" Left="255px" Top="2158px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 3RD family member" Binding="person_attribute49" Left="256px" Top="2198px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 4TH family member" Binding="person_attribute50" Left="255px" Top="2236px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="Inpatient care hospitalization" HelpText="INPATIENT CARE OR HOSPITALIZATION" Binding="5485" ParentBinding="person_attribute24" Left="258px" Top="1475px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="CheckBox" Text="Self referral and VCT" HelpText="Self-referral" Binding="160551" ParentBinding="person_attribute24" Left="481px" Top="1504px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Head household of the patient" Binding="person_attribute16" Left="14px" Top="459px" Width="319px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="telephone number of head household of the patient" Binding="person_attribute26" Left="649px" Top="461px" Width="154px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="CBHS number" Binding="person_attribute56" Left="549px" Top="566px" Width="200px" Height="25px" TabIndex="189" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="DSS number" Binding="person_attribute29" Left="11px" Top="636px" Width="164px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Other source of referral not specified" Binding="person_attribute25" Left="464px" Top="1538px" Width="311px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 1st family member" Binding="person_attribute41" Left="255px" Top="1874px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="DatePicker" HelpText="Date of first positive HIV test" Binding="person_attribute19" Left="222px" Top="1190px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="VCT number" Binding="person_attribute20" Left="632px" Top="1189px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="Yes, given today" Binding="161870" ParentBinding="person_attribute37" Left="208px" Top="1679px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Not signed for other reason" HelpText="Not signed for other reason" Binding="161940" ParentBinding="person_attribute37" Left="387px" Top="1708px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Other reasons for not signing consent form" Binding="person_attribute60" Left="202px" Top="1747px" Width="573px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Unique identification number of tb patient" Binding="person_attribute55" Left="132px" Top="566px" Width="200px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No, the patient refused" HelpText="No. do not ask again" Binding="161054" ParentBinding="person_attribute37" Left="337px" Top="1677px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 4TH family member" Binding="person_attribute51" Left="255px" Top="2278px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 1st family member" Binding="person_attribute42" Left="255px" Top="1916px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 1st family member" HelpText="Name of 1st family member" Binding="person_attribute41" Left="19px" Top="1879px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Unknown" HelpText="UNKNOWN" Binding="1067" ParentBinding="person_attribute40" Left="376px" Top="1837px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 4th family member" HelpText="NACPNO for 4TH family member" Binding="person_attribute52" Left="20px" Top="2330px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 4TH family member" Binding="person_attribute52" Left="256px" Top="2319px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Any family members attending CDCI?" HelpText="Any family members attending CDCI?" Binding="person_attribute40" Left="17px" Top="1842px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP449px" Left="0px" Top="1822px" Width="820px" Height="7px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="DatePicker" HelpText="Date of informed consent" Binding="person_attribute38" Left="243px" Top="1782px" Width="215px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP1168px" Left="0px" Top="1664px" Width="820px" Height="6px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="CheckBox" Text="With records(referral and CTC 1 forms)" HelpText="with records(referral and CTC 1 forms)" Binding="161049" ParentBinding="person_attribute36" Left="236px" Top="1634px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP1131px" Left="0px" Top="1578px" Width="820px" Height="8px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="CheckBox" Text="Other, specify" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute24" Left="259px" Top="1535px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP925px" Left="0px" Top="1366px" Width="820px" Height="5px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="TextBox" HelpText="support group" Binding="person_attribute23" Left="467px" Top="1325px" Width="322px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP834px" Left="0px" Top="1265px" Width="820px" Height="5px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="RadioButton" Text="Unknown" HelpText="UNKNOWN" Binding="1067" ParentBinding="person_attribute21" Left="612px" Top="1227px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP759px" Left="0px" Top="1174px" Width="820px" Height="5px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="TextBox" HelpText="Other health insurance specify" Binding="person_attribute59" Left="259px" Top="1134px" Width="522px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP759px" Left="0px" Top="951px" Width="820px" Height="5px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute17" Left="465px" Top="918px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP620px" Left="0px" Top="804px" Width="820px" Height="5px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute39" Left="748px" Top="763px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute39" Left="703px" Top="763px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="number of children" Binding="person_attribute32" Left="338px" Top="764px" Width="82px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute31" Left="133px" Top="766px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute31" Left="86px" Top="765px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP449px" Left="0px" Top="744px" Width="820px" Height="5px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute5" Left="401px" Top="709px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP449px" Left="0px" Top="553px" Width="820px" Height="6px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="TextBox" HelpText="Name of treatment support of this patient" Binding="person_attribute27" Left="15px" Top="518px" Width="319px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP333px" Left="0px" Top="433px" Width="821px" Height="4px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="TextBox" HelpText="telephone number of the patient" Binding="person_attribute14" Left="185px" Top="398px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="10 cell leader name" Binding="person_attribute15" Left="518px" Top="398px" Width="281px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="residence of this patient(Street)" Binding="person_attribute13" Left="636px" Top="353px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP249px" Left="-20px" Top="342px" Width="820px" Height="5px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="TextBox" HelpText="Other ward unspecified" Binding="person_attribute11" Left="632px" Top="309px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Lumemo" HelpText="LUMEMO" Binding="161010" ParentBinding="person_attribute10" Left="622px" Top="282px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Specify" HelpText="Label" Binding="LEFT384pxTOP222px" Left="571px" Top="316px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute10" Left="471px" Top="313px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kidatu" HelpText="KIDATU" Binding="161009" ParentBinding="person_attribute10" Left="471px" Top="286px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kiberege" HelpText="KIBEREGE" Binding="161008" ParentBinding="person_attribute10" Left="371px" Top="286px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP179px" Left="0px" Top="273px" Width="820px" Height="4px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="TextBox" HelpText="other unspecified district" Binding="person_attribute9" Left="631px" Top="239px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP139px" Left="0px" Top="228px" Width="820px" Height="4px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" backgroundColor="black"/><Item WidgetType="TextBox" HelpText="A well known name of a client" Binding="person_attribute53" Left="113px" Top="194px" Width="446px" Height="25px" TabIndex="189" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="First name" HelpText="The patient given name" Binding="given_name" Left="16px" Top="130px" Width="100px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Middle Name(s)" HelpText="The patient middle name" Binding="middle_name" Left="262px" Top="119px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient family name" Binding="family_name" Left="577px" Top="148px" Width="228px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text=" Patient ID Number" HelpText="The patient identifier" Binding="identifier" Left="8px" Top="82px" Width="144px" Height="13px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient identifier" Binding="identifier" Left="174px" Top="76px" Width="418px" Height="31px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Specify" HelpText="Label" Binding="LEFT508pxTOP155px" Left="571px" Top="242px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="residence of this patient(village)" Binding="person_attribute12" Left="185px" Top="358px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient middle name" Binding="middle_name" Left="262px" Top="151px" Width="298px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient given name" Binding="given_name" Left="17px" Top="152px" Width="221px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text=" What type of patient are you registering?" HelpText="The patient's identifier type" Binding="patient_identifier_type_id" Left="5px" Top="33px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text=" Newly Diagnosed" HelpText="NACPNO" Binding="3" ParentBinding="patient_identifier_type_id" Left="395px" Top="32px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="RadioButton" Text=" Exposed Infant" HelpText="HEI Number" Binding="5" ParentBinding="patient_identifier_type_id" Left="603px" Top="34px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Name of treatment supporter" HelpText="Name of treatment support of this patient" Binding="person_attribute27" Left="14px" Top="498px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Telephone number treatment supporter" HelpText="telephone number of treatment supporter of this patient" Binding="person_attribute28" Left="384px" Top="496px" Height="3px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Number of children" HelpText="number of children" Binding="person_attribute32" Left="204px" Top="768px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Any children who are <18 years of age" HelpText="Any children who are <16 years of age" Binding="person_attribute39" Left="438px" Top="766px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Type of health insurance scheme" HelpText="Type of health insurance scheme" Binding="person_attribute58" Left="15px" Top="1006px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Other health insurance specify" HelpText="Other health insurance specify" Binding="person_attribute59" Left="18px" Top="1134px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Date of first positive HIV test" HelpText="Date of first positive HIV test" Binding="person_attribute19" Left="12px" Top="1190px" Height="21px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="VCT number(SFRH only)" HelpText="VCT number" Binding="person_attribute20" Left="460px" Top="1195px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif" textDecoration="none"/><Item WidgetType="Label" Text="Name of organization/group" HelpText="support group" Binding="person_attribute23" Left="9px" Top="1329px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Other reasons specify" HelpText="Other reasons for not signing consent form" Binding="person_attribute60" Left="14px" Top="1749px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Date of informed consent" HelpText="Date of informed consent" Binding="person_attribute38" Left="14px" Top="1784px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Nick name" HelpText="A well known name of a client" Binding="person_attribute53" Left="26px" Top="198px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Ward" HelpText="residence of the patient(ward)" Binding="person_attribute10" Left="10px" Top="290px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Village" HelpText="residence of this patient(village)" Binding="person_attribute12" Left="15px" Top="358px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Telephone number" HelpText="telephone number of the patient" Binding="person_attribute14" Left="15px" Top="398px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Street" HelpText="residence of this patient(Street)" Binding="person_attribute13" Left="578px" Top="361px" Height="1px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 10 cell leader" HelpText="10 cell leader name" Binding="person_attribute15" Left="361px" Top="401px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Name of head of household" HelpText="Head household of the patient" Binding="person_attribute16" Left="12px" Top="439px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Telephone number head of household" HelpText="telephone number of head household of the patient" Binding="person_attribute26" Left="383px" Top="441px" Width="300px" Height="14px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="TB Number" HelpText="Unique identification number of tb patient" Binding="person_attribute55" Left="17px" Top="569px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="CBHS Number" HelpText="CBHS number" Binding="person_attribute56" Left="430px" Top="569px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="DSS number" HelpText="DSS number" Binding="person_attribute29" Left="12px" Top="618px" Height="6px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Date of birth" HelpText="The patient birth date" Binding="birth_date" Left="239px" Top="614px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Birth Date Estimated" HelpText="Is the patient birth date estimated?" Binding="person_attribute54" Left="474px" Top="621px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Sex" HelpText="The patient's sex" Binding="gender" Left="675px" Top="619px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Marital status" HelpText="Marriage status of this person" Binding="person_attribute5" Left="18px" Top="679px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Children" HelpText="This patient has children?" Binding="person_attribute31" Left="9px" Top="765px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Occupation" HelpText="Occupation of this patient" Binding="person_attribute34" Left="15px" Top="821px" Height="28px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Highest education level" HelpText="highest education level of the patient" Binding="person_attribute17" Left="16px" Top="889px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Do you have health insurance?" HelpText="Do you have health insurance?" Binding="person_attribute57" Left="15px" Top="967px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="HIV type" HelpText="HIV type" Binding="person_attribute21" Left="12px" Top="1229px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Patient joined community support organization" HelpText="community support" Binding="person_attribute22" Left="8px" Top="1281px" Height="5px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Patient referred from(select all that apply)" HelpText="patient referral source" Binding="person_attribute24" Left="8px" Top="1394px" Height="1px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Transfer in(select all that apply)" HelpText="Transfer in(select all that apply)" Binding="person_attribute36" Left="8px" Top="1594px" Height="1px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="Informed consent signed" HelpText="informed consent patient signed" Binding="person_attribute37" Left="10px" Top="1681px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/><Item WidgetType="Label" Text="District" HelpText="this is the residence of the patient (district)" Binding="person_attribute8" Left="11px" Top="236px" Height="9px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, "Lucida Grande", "Trebuchet MS", Arial, sans-serif"/></Item></Page></Form></Layout><Language><LanguageText lang="en"><xform id="0"><text xpath="xforms/model/instance/patient[@name]" value="Patient"/><text xpath="xforms/group[@id='1']/label" value="Page1"/><text xpath="xforms/group[@id='1']/input[@bind='family_name']/label" value="Last Name"/><text xpath="xforms/group[@id='1']/input[@bind='family_name']/hint" value="The patient family name"/><text xpath="xforms/group[@id='1']/input[@bind='middle_name']/label" value="Middle name"/><text xpath="xforms/group[@id='1']/input[@bind='middle_name']/hint" value="The patient middle name"/><text xpath="xforms/group[@id='1']/input[@bind='given_name']/label" value="First Name"/><text xpath="xforms/group[@id='1']/input[@bind='given_name']/hint" value="The patient given name"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date']/label" value="Date of birth"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date']/hint" value="The patient birth date"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date_estimated']/label" value="Birth Date Estimated"/><text xpath="xforms/group[@id='1']/input[@bind='birth_date_estimated']/hint" value="Is the patient birth date estimated?"/><text xpath="xforms/group[@id='1']/input[@bind='identifier']/label" value="NACP number"/><text xpath="xforms/group[@id='1']/input[@bind='identifier']/hint" value="The patient identifier"/><text xpath="xforms/group[@id='1']/input[@bind='patient_id']/label" value="Patient ID"/><text xpath="xforms/group[@id='1']/input[@bind='patient_id']/hint" value="The patient ID"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/label" value="Gender"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/hint" value="The patient's sex"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/item[@id='M']/label" value="Male"/><text xpath="xforms/group[@id='1']/select1[@bind='gender']/item[@id='F']/label" value="Female"/><text xpath="xforms/group[@id='1']/input[@bind='degree']/label" value="Degree"/><text xpath="xforms/group[@id='1']/input[@bind='degree']/hint" value="The patient name degree"/><text xpath="xforms/group[@id='1']/input[@bind='family_name2']/label" value="Family Name 2"/><text xpath="xforms/group[@id='1']/input[@bind='family_name2']/hint" value="The patient second family name"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_prefix']/label" value="Family Name Prefix"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_prefix']/hint" value="The patient family name prefix"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_suffix']/label" value="Family Name Suffix"/><text xpath="xforms/group[@id='1']/input[@bind='family_name_suffix']/hint" value="The patient family name suffix"/><text xpath="xforms/group[@id='1']/input[@bind='prefix']/label" value="Prefix"/><text xpath="xforms/group[@id='1']/input[@bind='prefix']/hint" value="The patient name prefix"/><text xpath="xforms/group[@id='1']/input[@bind='location_id']/label" value="Location"/><text xpath="xforms/group[@id='1']/input[@bind='location_id']/hint" value="The patient's location"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/label" value="Identifier Type"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/hint" value="The patient's identifier type"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/item[@id='2']/label" value="Old Identification Number"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/item[@id='1']/label" value="OpenMRS Identification Number"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/item[@id='3']/label" value="NACPNO"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/item[@id='5']/label" value="HEI Number"/><text xpath="xforms/group[@id='1']/select1[@bind='patient_identifier_type_id']/item[@id='4']/label" value="OpenEMPI ID"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute2']/label" value="Birthplace"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute2']/hint" value="Location of persons birth"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute3']/label" value="Citizenship"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute3']/hint" value="Country of which this person is a member"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/label" value="Civil Status"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/hint" value="Marriage status of this person"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/item[@id='1056']/label" value="SEPARATED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/item[@id='1057']/label" value="NEVER MARRIED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/item[@id='1058']/label" value="DIVORCED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/item[@id='1059']/label" value="WIDOWED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/item[@id='1060']/label" value="LIVING WITH PARTNER"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/item[@id='5555']/label" value="MARRIED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute5']/item[@id='5622']/label" value="OTHER NON-CODED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute7']/label" value="Health Center"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute7']/hint" value="Specific Location of this person's home health center."/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute7']/item[@id='1']/label" value="Unknown Location [1]"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute6']/label" value="Health District"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute6']/hint" value="District/region in which this patient' home health center resides"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute4']/label" value="Mother's Name"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute4']/hint" value="First or last name of this person's mother"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute1']/label" value="Race"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute1']/hint" value="Group of persons related by common descent or heredity"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_address1']/label" value="Address 1"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_address2']/label" value="Address 2"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_city_village']/label" value="City/Village"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_state_province']/label" value="State/Province"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_postal_code']/label" value="Postal Code"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_country']/label" value="Country"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_latitude']/label" value="Latitude"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_longitude']/label" value="Longitude"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_county_district']/label" value="County/District"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_neighborhood_cell']/label" value="Neighborhood Cell"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_region']/label" value="Region"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_subregion']/label" value="Sub Region"/><text xpath="xforms/group[@id='1']/input[@bind='person_address_township_division']/label" value="Township/Division"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/label" value="Other dentifiers"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/input[@bind='other_identifier']/label" value="Identifier"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/input[@bind='other_identifier']/hint" value="The patient's other identifier value"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/label" value="Identifier Type"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/hint" value="The patient's other identifier type"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/item[@id='2']/label" value="Old Identification Number"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/item[@id='1']/label" value="OpenMRS Identification Number"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/item[@id='3']/label" value="NACPNO"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/item[@id='5']/label" value="HEI Number"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_type_id']/item[@id='4']/label" value="OpenEMPI ID"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_location_id']/label" value="Identifier Location"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_location_id']/hint" value="The patient's other identifier location"/><text xpath="xforms/group[@id='1']/group[@id='other_identifiers']/repeat/select1[@bind='other_identifier_location_id']/item[@id='1']/label" value="Unknown Location [1]"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute8']/label" value="District"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute8']/hint" value="this is the residence of the patient (district)"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute8']/item[@id='161002']/label" value="KILOMBERO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute8']/item[@id='161003']/label" value="KILOSA"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute8']/item[@id='161004']/label" value="ULANGA"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute8']/item[@id='5622']/label" value="OTHER NON-CODED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute9']/label" value="Other distict(please specify)"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute9']/hint" value="other unspecified district"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/label" value="Ward"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/hint" value="residence of the patient(ward)"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161005']/label" value="IDETE"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161006']/label" value="IFAKARA"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161007']/label" value="KIBAONI"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161008']/label" value="KIBEREGE"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161009']/label" value="KIDATU"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161010']/label" value="LUMEMO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161011']/label" value="LUPIRO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161012']/label" value="MANG'ULA"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161014']/label" value="MLIMBA"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='161015']/label" value="MNGETA"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute10']/item[@id='5622']/label" value="OTHER NON-CODED"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute11']/label" value="Other ward(please specify)"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute11']/hint" value="Other ward unspecified"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute12']/label" value="Village"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute12']/hint" value="residence of this patient(village)"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute13']/label" value="Street"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute13']/hint" value="residence of this patient(Street)"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute14']/label" value="Telephone number"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute14']/hint" value="telephone number of the patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute15']/label" value="10CELL_LEADER"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute15']/hint" value="10 cell leader name"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute16']/label" value="HEADD_HOUSEHOLD"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute16']/hint" value="Head household of the patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute17']/label" value="EDUCATION"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute17']/hint" value="highest education level of the patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute17']/item[@id='1107']/label" value="NONE"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute17']/item[@id='1713']/label" value="PRIMARY SCHOOL EDUCATION"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute17']/item[@id='1714']/label" value="SECONDARY SCHOOL EDUCATION"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute17']/item[@id='159785']/label" value="college/university/polytechnic"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute17']/item[@id='5622']/label" value="OTHER NON-CODED"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute19']/label" value="DATE_FIRST_POS"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute19']/hint" value="Date of first positive HIV test"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute20']/label" value="VCT_NO"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute20']/hint" value="VCT number"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute21']/label" value="HIVTYPE"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute21']/hint" value="HIV type"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute21']/item[@id='161017']/label" value="HIV type I"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute21']/item[@id='161018']/label" value="HIV type II"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute21']/item[@id='161019']/label" value="Both"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute21']/item[@id='1067']/label" value="UNKNOWN"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute22']/label" value="COMM_SUPPORT"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute22']/hint" value="community support"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute22']/item[@id='1065']/label" value="YES"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute22']/item[@id='1066']/label" value="NO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute23']/label" value="SUPPORT_GROUP"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute23']/hint" value="support group"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/label" value="PAT_REF"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/hint" value="patient referral source"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='160542']/label" value="Outpatient department"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='161020']/label" value="PLHIV group"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='160546']/label" value="Sexually transmitted infection program/clinic"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='161039']/label" value="HBC"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='161021']/label" value="RCH/PMTCT/EID"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='5485']/label" value="Inpatient"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='5487']/label" value="Tuberculosis Treatment or DOT Program"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='160539']/label" value="Voluntary counseling and testing program"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='5622']/label" value="OTHER NON-CODED"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute24']/item[@id='160551^Self referral and VCT^99DCT']/label" value="Self referral and VCT"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute25']/label" value="OTHER_PATREF"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute25']/hint" value="Other source of referral not specified"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute26']/label" value="TELNO_HH"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute26']/hint" value="telephone number of head household of the patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute27']/label" value="TXT_SUPPORTER"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute27']/hint" value="Name of treatment support of this patient"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute28']/label" value="TELNO_TXTSUPP"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute28']/hint" value="telephone number of treatment supporter of this patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute29']/label" value="DSS_NO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute29']/hint" value="DSS number"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute31']/label" value="CHILDREN"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute31']/hint" value="This patient has children?"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute31']/item[@id='1065']/label" value="YES"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute31']/item[@id='1066']/label" value="NO"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute32']/label" value="NO_CHILD"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute32']/hint" value="number of children"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute33']/label" value="DOB_LAST_CHILD"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute33']/hint" value="Date of birth of the last children"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/label" value="OCCUPATION"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/hint" value="Occupation of this patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='1538']/label" value="FARMER"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='159465']/label" value="Student"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='161457']/label" value="Employee-private"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='161013']/label" value="Employee-government"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='161016']/label" value="self-employed"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='123801']/label" value="Unemployed"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='160295']/label" value="Housewife"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='159461']/label" value="Retired"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute34']/item[@id='5622']/label" value="OTHER NON-CODED"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute36']/label" value="TRANSFER_IN"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute36']/hint" value="Transfer in(select all that apply)"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute36']/item[@id='1175']/label" value="NOT APPLICABLE"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute36']/item[@id='161049']/label" value="with records(referral and CTC 1 forms)"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute36']/item[@id='161050']/label" value="No records available"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute36']/item[@id='161051']/label" value="In care"/><text xpath="xforms/group[@id='1']/select[@bind='person_attribute36']/item[@id='161052']/label" value="On ART"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/label" value="CONSENT"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/hint" value="informed consent patient signed"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/item[@id='161053']/label" value="No. but ask again later"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/item[@id='161054']/label" value="No, the patient refused"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/item[@id='161869']/label" value="Form given to take home"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/item[@id='161870']/label" value="Yes, given today"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/item[@id='161871']/label" value="Yes, and consent use of data since baseline"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/item[@id='161939']/label" value="No, Patient too sick to be asked"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute37']/item[@id='161940']/label" value="Not signed for other reason"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute38']/label" value="DATE_CONSENT"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute38']/hint" value="Date of informed consent"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute18']/label" value="EDU_OTHER"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute18']/hint" value="Other education level"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute35']/label" value="OCCUP_OTHER"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute35']/hint" value="Occupation of this patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute39']/label" value="CHILDREN_LESS16"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute39']/hint" value="Any children who are <16 years of age"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute39']/item[@id='1066']/label" value="NO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute39']/item[@id='1065']/label" value="YES"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute40']/label" value="FAMILY_CDCI"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute40']/hint" value="Any family members attending CDCI?"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute40']/item[@id='1066']/label" value="NO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute40']/item[@id='1065']/label" value="YES"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute40']/item[@id='1067']/label" value="UNKNOWN"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute41']/label" value="FAMILY_NAME1"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute41']/hint" value="Name of 1st family member"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute42']/label" value="FAMILY_RELATION1"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute42']/hint" value="Relationship of 1st family member"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute43']/label" value="FAMILY_NACP1"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute43']/hint" value="NACPNO for 1st family member"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute44']/label" value="FAMILY_NAME2"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute44']/hint" value="Name of 2nd family member"/><text 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xpath="xforms/group[@id='1']/input[@bind='person_attribute54']/label" value="Birth Date Estimated"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute54']/hint" value="Is the patient birth date estimated?"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute55']/label" value="TB_NO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute55']/hint" value="Unique identification number of tb patient"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute56']/label" value="CBHS_NO"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute56']/hint" value="CBHS number"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute57']/label" value="HEALTH_INSURANCE"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute57']/hint" value="Do you have health insurance?"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/label" value="HEALTH_INSURANCE_TYPE"/><text 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more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute12'][@message]" value=""/><text xpath="xforms/model/bind[@id='person_attribute13'][@message]" value=""/><text xpath="xforms/model/bind[@id='person_attribute14'][@message]" value="Data out of range"/><text xpath="xforms/model/bind[@id='person_attribute15'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute16'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute20'][@message]" value="Data out of range"/><text xpath="xforms/model/bind[@id='person_attribute23'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute26'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute27'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute28'][@message]" value="Data out of range"/><text xpath="xforms/model/bind[@id='person_attribute29'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute32'][@message]" value="Data out of range"/><text xpath="xforms/model/bind[@id='person_attribute38'][@message]" value="Date here is not allowed to be in the future please check"/><text xpath="xforms/model/bind[@id='person_attribute41'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute42'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute43'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute44'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute45'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute46'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute47'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute48'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute49'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text 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xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="465px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159461' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Retired"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159461' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="Retired"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159461' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="849px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159461' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="328px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160295' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Housewife"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160295' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="Housewife"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160295' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="848px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160295' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="225px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='123801' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Unemployed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='123801' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="Unemployed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='123801' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="849px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='123801' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="106px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1538' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Farmer"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1538' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="FARMER"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1538' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="819px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1538' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="106px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159465' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Student"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159465' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="Student"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159465' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="819px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159465' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="225px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161457' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Employee-private"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161457' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="Employee-private"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161457' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="818px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161457' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="329px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161013' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Employee-government"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161013' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="Employee-government"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161013' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="819px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161013' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="465px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159785' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Text]" value="College/University"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159785' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@HelpText]" value="college/university/polytechnic"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159785' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Top]" value="918px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='159785' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Left]" value="225px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1713' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Text]" value="Primary school education"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1713' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@HelpText]" value="PRIMARY SCHOOL EDUCATION"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1713' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Top]" value="882px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1713' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Left]" value="325px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1107' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Text]" value="None"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1107' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@HelpText]" value="NONE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1107' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Top]" value="882px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1107' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Left]" value="225px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161016' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Self-employed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161016' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@HelpText]" value="self-employed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161016' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Top]" value="821px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161016' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Left]" value="672px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1714' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Text]" value="Secondary school education"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1714' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@HelpText]" value="SECONDARY SCHOOL EDUCATION"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1714' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Top]" value="883px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1714' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Left]" value="523px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='TextBox'][@HelpText]" value="telephone number of treatment supporter of this patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='TextBox'][@Top]" value="515px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='TextBox'][@Left]" value="646px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='TextBox'][@Width]" value="159px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161015' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Mngeta"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161015' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="MNGETA"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161015' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="316px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161015' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="370px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161014' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Mlimba"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161014' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="MLIMBA"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161014' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="316px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161014' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="270px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161007' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Kibaoni"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161007' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="KIBAONI"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161007' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="287px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161007' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="270px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161012' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Mang'ula"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161012' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="MANG'ULA"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161012' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="314px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161012' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="170px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161006' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Ifakara"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161006' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="IFAKARA"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161006' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="287px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161006' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="170px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161011' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Lupiro"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161011' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="LUPIRO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161011' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="317px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161011' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="70px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161005' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Idete"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161005' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="IDETE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161005' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="289px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161005' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="70px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Text]" value="Other"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@HelpText]" value="OTHER NON-CODED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Top]" value="240px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Left]" value="371px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161004' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Text]" value="Ulanga"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161004' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@HelpText]" value="ULANGA"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161004' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Top]" value="241px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161004' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Left]" value="271px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161003' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Text]" value="Kilosa"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161003' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@HelpText]" value="KILOSA"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161003' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Top]" value="239px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161003' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Left]" value="171px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161002' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Text]" value="Kilombero"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161002' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@HelpText]" value="KILOMBERO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161002' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Top]" value="239px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161002' and @ParentBinding='person_attribute8' and @WidgetType='RadioButton'][@Left]" value="71px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='Label'][@Text]" value="Last name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='Label'][@HelpText]" value="The patient family name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='Label'][@Top]" value="119px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='Label'][@Left]" value="576px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Text]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Top]" value="1838px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Left]" value="323px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Text]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@HelpText]" value="NO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Top]" value="1838px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Left]" value="275px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='Label'][@Text]" value="Relationship of 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='Label'][@HelpText]" value="Relationship of 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='Label'][@Top]" value="1930px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='Label'][@Left]" value="21px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute43' and @WidgetType='Label'][@Text]" value="NACPNO for 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute43' and @WidgetType='Label'][@HelpText]" value="NACPNO for 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute43' and @WidgetType='Label'][@Top]" value="1968px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute43' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='Label'][@Text]" value="Name of 2nd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='Label'][@HelpText]" value="Name of 2nd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='Label'][@Top]" value="2007px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='Label'][@Text]" value="Relationship of 2nd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='Label'][@HelpText]" value="Relationship of 2ND family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='Label'][@Top]" value="2049px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='Label'][@Text]" value="NACPNO for 2nd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='Label'][@HelpText]" value="NACPNO for 2ND family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='Label'][@Top]" value="2086px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='Label'][@Text]" value="Name of 3rd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='Label'][@HelpText]" value="Name of 3RD family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='Label'][@Top]" value="2129px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='Label'][@Text]" value="Relationship of 3rd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='Label'][@HelpText]" value="Relationship of 3RD family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='Label'][@Top]" value="2170px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='Label'][@Text]" value="NACPNO for 3rd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='Label'][@HelpText]" value="NACPNO for 3RD family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='Label'][@Top]" value="2211px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='Label'][@Left]" value="20px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='Label'][@Text]" value="Name of 4th family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='Label'][@HelpText]" value="Name of 4TH family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='Label'][@Top]" value="2251px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='Label'][@Text]" value="Relationship of 4th family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='Label'][@HelpText]" value="Relationship of 4TH family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='Label'][@Top]" value="2286px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161939' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Text]" value="No, Patient too sick to be asked"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161939' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@HelpText]" value="No, Patient too sick to be asked"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161939' and 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xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161052' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Left]" value="706px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1175' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Text]" value="Not applicable"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1175' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@HelpText]" value="NOT APPLICABLE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1175' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Top]" value="1595px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1175' and 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xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161051' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Text]" value="In care"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161051' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@HelpText]" value="In care"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161051' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Top]" value="1635px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161051' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Left]" value="529px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161020' and 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xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161039' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="HBC"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161039' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1445px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161039' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="258px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161021' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="RCH/PMTCT/EID"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161021' and 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infection program/clinic"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160546' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1445px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160546' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="478px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160542' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="OPD"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160542' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="Outpatient department"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160542' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1420px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160542' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="258px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5487' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="TB or DOT Program"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5487' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="Tuberculosis Treatment or DOT Program"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5487' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1420px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5487' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="478px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161019' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Text]" value="Both"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161019' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@HelpText]" value="Both"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161019' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Top]" value="1226px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161019' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Left]" value="462px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161018' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Text]" value="HIV type II"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161018' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@HelpText]" value="HIV type II"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161018' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Top]" value="1225px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161018' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Left]" value="322px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161017' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Text]" value="HIV type I"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161017' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@HelpText]" value="HIV type I"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161017' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Top]" value="1225px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161017' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Left]" value="222px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1056' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Text]" value="Separated"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1056' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@HelpText]" value="SEPARATED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1056' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Top]" value="679px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1056' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Left]" value="571px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1060' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Text]" value="Living with partner"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1060' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@HelpText]" value="LIVING WITH PARTNER"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1060' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Top]" value="679px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1060' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Left]" value="401px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1059' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Text]" value="Widowed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1059' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@HelpText]" value="WIDOWED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1059' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Top]" value="709px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1059' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Left]" value="301px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5555' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Text]" value="Married"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5555' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@HelpText]" value="MARRIED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5555' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Top]" value="679px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5555' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Left]" value="301px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1058' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Text]" value="Divorced"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1058' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@HelpText]" value="DIVORCED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1058' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Top]" value="709px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1058' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Left]" value="171px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1057' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Text]" value="Never married"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1057' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@HelpText]" value="NEVER MARRIED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1057' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Top]" value="679px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1057' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Left]" value="170px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@HelpText]" value="The patient birth date"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@Top]" value="638px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@Left]" value="240px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='DatePicker'][@Width]" value="167px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162044' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Text]" value="National Health Insurance Fund (NHIF)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162044' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@HelpText]" value="NHIF"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162044' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Top]" value="1005px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162044' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Left]" value="256px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162046' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Text]" value="Community Health Fund (CHF)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162046' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@HelpText]" value="CHF"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162046' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Top]" value="1047px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162046' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Left]" value="576px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and 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value="1958px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute43' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute43' and @WidgetType='TextBox'][@Width]" value="250px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='TextBox'][@HelpText]" value="Name of 2nd family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='TextBox'][@Top]" value="1998px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute44' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='TextBox'][@HelpText]" value="Relationship of 2ND family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='TextBox'][@Top]" value="2038px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute45' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='TextBox'][@HelpText]" value="NACPNO for 2ND family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='TextBox'][@Top]" value="2079px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='TextBox'][@Left]" value="256px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute46' and @WidgetType='TextBox'][@Width]" value="250px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='TextBox'][@HelpText]" value="Name of 3RD family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='TextBox'][@Top]" value="2118px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute47' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='TextBox'][@HelpText]" value="Relationship of 3RD family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='TextBox'][@Top]" value="2158px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute48' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='TextBox'][@HelpText]" value="NACPNO for 3RD family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='TextBox'][@Top]" value="2198px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='TextBox'][@Left]" value="256px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute49' and @WidgetType='TextBox'][@Width]" value="250px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='TextBox'][@HelpText]" value="Name of 4TH family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='TextBox'][@Top]" value="2236px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute50' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5485' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="Inpatient care hospitalization"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5485' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="INPATIENT CARE OR HOSPITALIZATION"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5485' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1475px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5485' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="258px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160551' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="Self referral and VCT"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160551' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="Self-referral"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160551' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1504px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160551' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="481px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='TextBox'][@HelpText]" value="Head household of the patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='TextBox'][@Top]" value="459px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='TextBox'][@Left]" value="14px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='TextBox'][@Width]" value="319px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='TextBox'][@HelpText]" value="telephone number of head household of the patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='TextBox'][@Top]" value="461px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='TextBox'][@Left]" value="649px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='TextBox'][@Width]" value="154px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='TextBox'][@HelpText]" value="CBHS number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='TextBox'][@Top]" value="566px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='TextBox'][@Left]" value="549px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='TextBox'][@HelpText]" value="DSS number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='TextBox'][@Top]" value="636px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='TextBox'][@Left]" value="11px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='TextBox'][@Width]" value="164px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute25' and @WidgetType='TextBox'][@HelpText]" value="Other source of referral not specified"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute25' and @WidgetType='TextBox'][@Top]" value="1538px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute25' and @WidgetType='TextBox'][@Left]" value="464px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute25' and @WidgetType='TextBox'][@Width]" value="311px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='TextBox'][@HelpText]" value="Name of 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='TextBox'][@Top]" value="1874px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='DatePicker'][@HelpText]" value="Date of first positive HIV test"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='DatePicker'][@Top]" value="1190px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='DatePicker'][@Left]" value="222px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='DatePicker'][@Width]" value="160px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='TextBox'][@HelpText]" value="VCT number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='TextBox'][@Top]" value="1189px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='TextBox'][@Left]" value="632px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='TextBox'][@Width]" value="160px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161870' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Text]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161870' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@HelpText]" value="Yes, given today"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161870' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Top]" value="1679px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161870' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Left]" value="208px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161940' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Text]" value="Not signed for other reason"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161940' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@HelpText]" value="Not signed for other reason"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161940' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Top]" value="1708px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161940' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Left]" value="387px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='TextBox'][@HelpText]" value="Other reasons for not signing consent form"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='TextBox'][@Top]" value="1747px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='TextBox'][@Left]" value="202px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='TextBox'][@Width]" value="573px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='TextBox'][@HelpText]" value="Unique identification number of tb patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='TextBox'][@Top]" value="566px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='TextBox'][@Left]" value="132px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='TextBox'][@Width]" value="200px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161054' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Text]" value="No, the patient refused"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161054' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@HelpText]" value="No. do not ask again"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161054' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Top]" value="1677px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161054' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Left]" value="337px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='TextBox'][@HelpText]" value="Relationship of 4TH family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='TextBox'][@Top]" value="2278px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute51' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='TextBox'][@HelpText]" value="Relationship of 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='TextBox'][@Top]" value="1916px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='TextBox'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute42' and @WidgetType='TextBox'][@Width]" value="550px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='Label'][@Text]" value="Name of 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='Label'][@HelpText]" value="Name of 1st family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='Label'][@Top]" value="1879px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute41' and @WidgetType='Label'][@Left]" value="19px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Text]" value="Unknown"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@HelpText]" value="UNKNOWN"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Top]" value="1837px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute40' and @WidgetType='RadioButton'][@Left]" value="376px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='Label'][@Text]" value="NACPNO for 4th family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='Label'][@HelpText]" value="NACPNO for 4TH family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='Label'][@Top]" value="2330px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='Label'][@Left]" value="20px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='TextBox'][@HelpText]" value="NACPNO for 4TH family member"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='TextBox'][@Top]" value="2319px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='TextBox'][@Left]" value="256px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute52' and @WidgetType='TextBox'][@Width]" value="250px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute40' and @WidgetType='Label'][@Text]" value="Any family members attending CDCI?"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute40' and @WidgetType='Label'][@HelpText]" value="Any family members attending CDCI?"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute40' and @WidgetType='Label'][@Top]" value="1842px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute40' and @WidgetType='Label'][@Left]" value="17px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Top]" value="1822px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='DatePicker'][@HelpText]" value="Date of informed consent"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='DatePicker'][@Top]" value="1782px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='DatePicker'][@Left]" value="243px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='DatePicker'][@Width]" value="215px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1168px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1168px' and @WidgetType='Label'][@Top]" value="1664px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1168px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1168px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161049' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Text]" value="With records(referral and CTC 1 forms)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161049' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@HelpText]" value="with records(referral and CTC 1 forms)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161049' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Top]" value="1634px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161049' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Left]" value="236px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1131px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1131px' and @WidgetType='Label'][@Top]" value="1578px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1131px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP1131px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="Other, specify"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="OTHER NON-CODED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1535px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="259px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP925px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP925px' and @WidgetType='Label'][@Top]" value="1366px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP925px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP925px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='TextBox'][@HelpText]" value="support group"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='TextBox'][@Top]" value="1325px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='TextBox'][@Left]" value="467px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='TextBox'][@Width]" value="322px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP834px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP834px' and @WidgetType='Label'][@Top]" value="1265px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP834px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP834px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Text]" value="Unknown"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@HelpText]" value="UNKNOWN"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Top]" value="1227px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1067' and @ParentBinding='person_attribute21' and @WidgetType='RadioButton'][@Left]" value="612px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@Top]" value="1174px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='TextBox'][@HelpText]" value="Other health insurance specify"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='TextBox'][@Top]" value="1134px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='TextBox'][@Left]" value="259px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='TextBox'][@Width]" value="522px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@Top]" value="951px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP759px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Text]" value="Other"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@HelpText]" value="OTHER NON-CODED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Top]" value="918px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute17' and @WidgetType='RadioButton'][@Left]" value="465px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP620px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP620px' and @WidgetType='Label'][@Top]" value="804px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP620px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP620px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Text]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Top]" value="763px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Left]" value="748px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Text]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@HelpText]" value="NO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Top]" value="763px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Left]" value="703px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='TextBox'][@HelpText]" value="number of children"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='TextBox'][@Top]" value="764px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='TextBox'][@Left]" value="338px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='TextBox'][@Width]" value="82px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Text]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Top]" value="766px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Left]" value="133px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Text]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@HelpText]" value="NO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Top]" value="765px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Left]" value="86px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Top]" value="744px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Text]" value="Other"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@HelpText]" value="OTHER NON-CODED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Top]" value="709px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute5' and @WidgetType='RadioButton'][@Left]" value="401px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Top]" value="553px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP449px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='TextBox'][@HelpText]" value="Name of treatment support of this patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='TextBox'][@Top]" value="518px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='TextBox'][@Left]" value="15px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='TextBox'][@Width]" value="319px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP333px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP333px' and @WidgetType='Label'][@Top]" value="433px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP333px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP333px' and @WidgetType='Label'][@Width]" value="821px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='TextBox'][@HelpText]" value="telephone number of the patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='TextBox'][@Top]" value="398px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='TextBox'][@Left]" value="185px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='TextBox'][@Width]" value="160px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='TextBox'][@HelpText]" value="10 cell leader name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='TextBox'][@Top]" value="398px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='TextBox'][@Left]" value="518px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='TextBox'][@Width]" value="281px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='TextBox'][@HelpText]" value="residence of this patient(Street)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='TextBox'][@Top]" value="353px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='TextBox'][@Left]" value="636px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='TextBox'][@Width]" value="160px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@Top]" value="342px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@Left]" value="-20px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute11' and @WidgetType='TextBox'][@HelpText]" value="Other ward unspecified"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute11' and @WidgetType='TextBox'][@Top]" value="309px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute11' and @WidgetType='TextBox'][@Left]" value="632px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute11' and @WidgetType='TextBox'][@Width]" value="160px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161010' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Lumemo"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161010' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="LUMEMO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161010' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="282px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161010' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="622px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT384pxTOP222px' and @WidgetType='Label'][@Text]" value="Specify"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT384pxTOP222px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT384pxTOP222px' and @WidgetType='Label'][@Top]" value="316px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT384pxTOP222px' and @WidgetType='Label'][@Left]" value="571px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Other"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="OTHER NON-CODED"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="313px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="471px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161009' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Kidatu"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161009' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="KIDATU"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161009' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="286px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161009' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="471px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161008' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Text]" value="Kiberege"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161008' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@HelpText]" value="KIBEREGE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161008' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Top]" value="286px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161008' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="371px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP179px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP179px' and @WidgetType='Label'][@Top]" value="273px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP179px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP179px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute9' and @WidgetType='TextBox'][@HelpText]" value="other unspecified district"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute9' and @WidgetType='TextBox'][@Top]" value="239px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute9' and @WidgetType='TextBox'][@Left]" value="631px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute9' and @WidgetType='TextBox'][@Width]" value="160px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP139px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP139px' and @WidgetType='Label'][@Top]" value="228px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP139px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP139px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='TextBox'][@HelpText]" value="A well known name of a client"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='TextBox'][@Top]" value="194px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='TextBox'][@Left]" value="113px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='TextBox'][@Width]" value="446px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='Label'][@Text]" value="First name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='Label'][@HelpText]" value="The patient given name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='Label'][@Top]" value="130px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='Label'][@Left]" value="16px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='Label'][@Width]" value="100px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='Label'][@Text]" value="Middle Name(s)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='Label'][@HelpText]" value="The patient middle name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='Label'][@Top]" value="119px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='Label'][@Left]" value="262px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='TextBox'][@HelpText]" value="The patient family name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='TextBox'][@Top]" value="148px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='TextBox'][@Left]" value="577px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='TextBox'][@Width]" value="228px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='Label'][@Text]" value=" Patient ID Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='Label'][@HelpText]" value="The patient identifier"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='Label'][@Top]" value="82px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='Label'][@Left]" value="8px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='Label'][@Width]" value="144px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='TextBox'][@HelpText]" value="The patient identifier"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Top]" value="76px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Left]" value="174px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Width]" value="418px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT508pxTOP155px' and @WidgetType='Label'][@Text]" value="Specify"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT508pxTOP155px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT508pxTOP155px' and @WidgetType='Label'][@Top]" value="242px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT508pxTOP155px' and @WidgetType='Label'][@Left]" value="571px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='TextBox'][@HelpText]" value="residence of this patient(village)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='TextBox'][@Top]" value="358px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='TextBox'][@Left]" value="185px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='TextBox'][@Width]" value="160px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@HelpText]" value="The patient middle name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@Top]" value="151px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@Left]" value="262px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@Width]" value="298px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='TextBox'][@HelpText]" value="The patient given name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='TextBox'][@Top]" value="152px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='TextBox'][@Left]" value="17px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='TextBox'][@Width]" value="221px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@Text]" value=" What type of patient are you registering?"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@HelpText]" value="The patient's identifier type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@Top]" value="33px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='patient_identifier_type_id' and @WidgetType='Label'][@Left]" value="5px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='3' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@Text]" value=" Newly Diagnosed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='3' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@HelpText]" value="NACPNO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='3' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@Top]" value="32px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='3' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@Left]" value="395px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@Text]" value=" Exposed Infant"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@HelpText]" value="HEI Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@Top]" value="34px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5' and @ParentBinding='patient_identifier_type_id' and @WidgetType='RadioButton'][@Left]" value="603px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='Label'][@Text]" value="Name of treatment supporter"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='Label'][@HelpText]" value="Name of treatment support of this patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='Label'][@Top]" value="498px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute27' and @WidgetType='Label'][@Left]" value="14px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='Label'][@Text]" value="Telephone number treatment supporter"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='Label'][@HelpText]" value="telephone number of treatment supporter of this patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='Label'][@Top]" value="496px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute28' and @WidgetType='Label'][@Left]" value="384px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='Label'][@Text]" value="Number of children"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='Label'][@HelpText]" value="number of children"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='Label'][@Top]" value="768px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='Label'][@Left]" value="204px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute39' and @WidgetType='Label'][@Text]" value="Any children who are <18 years of age"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute39' and @WidgetType='Label'][@HelpText]" value="Any children who are <16 years of age"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute39' and @WidgetType='Label'][@Top]" value="766px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute39' and @WidgetType='Label'][@Left]" value="438px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute58' and @WidgetType='Label'][@Text]" value="Type of health insurance scheme"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute58' and @WidgetType='Label'][@HelpText]" value="Type of health insurance scheme"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute58' and @WidgetType='Label'][@Top]" value="1006px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute58' and @WidgetType='Label'][@Left]" value="15px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='Label'][@Text]" value="Other health insurance specify"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='Label'][@HelpText]" value="Other health insurance specify"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='Label'][@Top]" value="1134px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute59' and @WidgetType='Label'][@Left]" value="18px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='Label'][@Text]" value="Date of first positive HIV test"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='Label'][@HelpText]" value="Date of first positive HIV test"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='Label'][@Top]" value="1190px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute19' and @WidgetType='Label'][@Left]" value="12px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='Label'][@Text]" value="VCT number(SFRH only)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='Label'][@HelpText]" value="VCT number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='Label'][@Top]" value="1195px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute20' and @WidgetType='Label'][@Left]" value="460px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='Label'][@Text]" value="Name of organization/group"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='Label'][@HelpText]" value="support group"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='Label'][@Top]" value="1329px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute23' and @WidgetType='Label'][@Left]" value="9px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='Label'][@Text]" value="Other reasons specify"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='Label'][@HelpText]" value="Other reasons for not signing consent form"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='Label'][@Top]" value="1749px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute60' and @WidgetType='Label'][@Left]" value="14px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='Label'][@Text]" value="Date of informed consent"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='Label'][@HelpText]" value="Date of informed consent"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='Label'][@Top]" value="1784px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute38' and @WidgetType='Label'][@Left]" value="14px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='Label'][@Text]" value="Nick name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='Label'][@HelpText]" value="A well known name of a client"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='Label'][@Top]" value="198px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='Label'][@Left]" value="26px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute10' and @WidgetType='Label'][@Text]" value="Ward"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute10' and @WidgetType='Label'][@HelpText]" value="residence of the patient(ward)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute10' and @WidgetType='Label'][@Top]" value="290px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute10' and @WidgetType='Label'][@Left]" value="10px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='Label'][@Text]" value="Village"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='Label'][@HelpText]" value="residence of this patient(village)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='Label'][@Top]" value="358px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='Label'][@Left]" value="15px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='Label'][@Text]" value="Telephone number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='Label'][@HelpText]" value="telephone number of the patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='Label'][@Top]" value="398px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='Label'][@Left]" value="15px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='Label'][@Text]" value="Street"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='Label'][@HelpText]" value="residence of this patient(Street)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='Label'][@Top]" value="361px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='Label'][@Left]" value="578px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='Label'][@Text]" value="Name of 10 cell leader"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='Label'][@HelpText]" value="10 cell leader name"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='Label'][@Top]" value="401px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='Label'][@Left]" value="361px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='Label'][@Text]" value="Name of head of household"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='Label'][@HelpText]" value="Head household of the patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='Label'][@Top]" value="439px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute16' and @WidgetType='Label'][@Left]" value="12px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='Label'][@Text]" value="Telephone number head of household"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='Label'][@HelpText]" value="telephone number of head household of the patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='Label'][@Top]" value="441px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='Label'][@Left]" value="383px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute26' and @WidgetType='Label'][@Width]" value="300px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='Label'][@Text]" value="TB Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='Label'][@HelpText]" value="Unique identification number of tb patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='Label'][@Top]" value="569px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute55' and @WidgetType='Label'][@Left]" value="17px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='Label'][@Text]" value="CBHS Number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='Label'][@HelpText]" value="CBHS number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='Label'][@Top]" value="569px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute56' and @WidgetType='Label'][@Left]" value="430px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='Label'][@Text]" value="DSS number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='Label'][@HelpText]" value="DSS number"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='Label'][@Top]" value="618px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute29' and @WidgetType='Label'][@Left]" value="12px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='Label'][@Text]" value="Date of birth"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='Label'][@HelpText]" value="The patient birth date"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='Label'][@Top]" value="614px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='birth_date' and @WidgetType='Label'][@Left]" value="239px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute54' and @WidgetType='Label'][@Text]" value="Birth Date Estimated"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute54' and @WidgetType='Label'][@HelpText]" value="Is the patient birth date estimated?"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute54' and @WidgetType='Label'][@Top]" value="621px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute54' and @WidgetType='Label'][@Left]" value="474px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='gender' and @WidgetType='Label'][@Text]" value="Sex"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='gender' and @WidgetType='Label'][@HelpText]" value="The patient's sex"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='gender' and @WidgetType='Label'][@Top]" value="619px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='gender' and @WidgetType='Label'][@Left]" value="675px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute5' and @WidgetType='Label'][@Text]" value="Marital status"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute5' and @WidgetType='Label'][@HelpText]" value="Marriage status of this person"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute5' and @WidgetType='Label'][@Top]" value="679px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute5' and @WidgetType='Label'][@Left]" value="18px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute31' and @WidgetType='Label'][@Text]" value="Children"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute31' and @WidgetType='Label'][@HelpText]" value="This patient has children?"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute31' and @WidgetType='Label'][@Top]" value="765px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute31' and @WidgetType='Label'][@Left]" value="9px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute34' and @WidgetType='Label'][@Text]" value="Occupation"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute34' and @WidgetType='Label'][@HelpText]" value="Occupation of this patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute34' and @WidgetType='Label'][@Top]" value="821px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute34' and @WidgetType='Label'][@Left]" value="15px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute17' and @WidgetType='Label'][@Text]" value="Highest education level"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute17' and @WidgetType='Label'][@HelpText]" value="highest education level of the patient"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute17' and @WidgetType='Label'][@Top]" value="889px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute17' and @WidgetType='Label'][@Left]" value="16px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute57' and @WidgetType='Label'][@Text]" value="Do you have health insurance?"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute57' and @WidgetType='Label'][@HelpText]" value="Do you have health insurance?"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute57' and @WidgetType='Label'][@Top]" value="967px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute57' and @WidgetType='Label'][@Left]" value="15px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute21' and @WidgetType='Label'][@Text]" value="HIV type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute21' and @WidgetType='Label'][@HelpText]" value="HIV type"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute21' and @WidgetType='Label'][@Top]" value="1229px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute21' and @WidgetType='Label'][@Left]" value="12px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute22' and @WidgetType='Label'][@Text]" value="Patient joined community support organization"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute22' and @WidgetType='Label'][@HelpText]" value="community support"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute22' and @WidgetType='Label'][@Top]" value="1281px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute22' and @WidgetType='Label'][@Left]" value="8px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute24' and @WidgetType='Label'][@Text]" value="Patient referred from(select all that apply)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute24' and @WidgetType='Label'][@HelpText]" value="patient referral source"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute24' and @WidgetType='Label'][@Top]" value="1394px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute24' and @WidgetType='Label'][@Left]" value="8px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute36' and @WidgetType='Label'][@Text]" value="Transfer in(select all that apply)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute36' and @WidgetType='Label'][@HelpText]" value="Transfer in(select all that apply)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute36' and @WidgetType='Label'][@Top]" value="1594px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute36' and @WidgetType='Label'][@Left]" value="8px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute37' and @WidgetType='Label'][@Text]" value="Informed consent signed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute37' and @WidgetType='Label'][@HelpText]" value="informed consent patient signed"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute37' and @WidgetType='Label'][@Top]" value="1681px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute37' and @WidgetType='Label'][@Left]" value="10px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute8' and @WidgetType='Label'][@Text]" value="District"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute8' and @WidgetType='Label'][@HelpText]" value="this is the residence of the patient (district)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute8' and @WidgetType='Label'][@Top]" value="236px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute8' and @WidgetType='Label'][@Left]" value="11px"/></Form></LanguageText></Language></PurcForm>
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