<org.openmrs.module.htmlformentry.SerializableFormObject>
  <patientIdentifier>1684AM-0</patientIdentifier>
  <patientUuid>dd713c1f-1691-11df-97a5-7038c432aabf</patientUuid>
  <encounterUuid>222b549a-cef4-4079-854b-7ea653c48e30</encounterUuid>
  <parameterMap>
    <entry>
      <string>returnUrl</string>
      <string-array>
        <string></string>
      </string-array>
    </entry>
    <entry>
      <string>patientId</string>
      <string-array>
        <string>1685</string>
      </string-array>
    </entry>
    <entry>
      <string>htmlFormId</string>
      <string-array>
        <string>3</string>
      </string-array>
    </entry>
    <entry>
      <string>formId</string>
      <string-array>
        <string>467</string>
      </string-array>
    </entry>
    <entry>
      <string>w3</string>
      <string-array>
        <string>4</string>
      </string-array>
    </entry>
    <entry>
      <string>personId</string>
      <string-array>
        <string>1685</string>
      </string-array>
    </entry>
    <entry>
      <string>encounterModifiedTimestamp</string>
      <string-array>
        <string>0</string>
      </string-array>
    </entry>
    <entry>
      <string>hasChangedInd</string>
      <string-array>
        <string>true</string>
      </string-array>
    </entry>
    <entry>
      <string>w5</string>
      <string-array>
        <string>1</string>
      </string-array>
    </entry>
    <entry>
      <string>closeAfterSubmission</string>
      <string-array>
        <string></string>
      </string-array>
    </entry>
    <entry>
      <string>w1</string>
      <string-array>
        <string>2015-02-01</string>
      </string-array>
    </entry>
    <entry>
      <string>formModifiedTimestamp</string>
      <string-array>
        <string>1422376174000</string>
      </string-array>
    </entry>
  </parameterMap>
  <xmlDefinition>&lt;htmlform&gt;&#xd;
	&lt;!-- Autogenerated example form  (template from 01-Nov-2010 --&gt;&#xd;
	&lt;macros&gt;&#xd;
		paperFormId = (Fill this in)&#xd;
		headerColor =#009d8e&#xd;
		fontOnHeaderColor = white&#xd;
	&lt;/macros&gt;&#xd;
&#xd;
	&lt;style&gt;&#xd;
		.section {&#xd;
			border: 1px solid $headerColor;&#xd;
			padding: 2px;&#xd;
			text-align: left;&#xd;
			margin-bottom: 1em;&#xd;
		}&#xd;
		.sectionHeader {&#xd;
			background-color: $headerColor;&#xd;
			color: $fontOnHeaderColor;&#xd;
			display: block;&#xd;
			padding: 2px;&#xd;
			font-weight: bold;&#xd;
		}&#xd;
		table.baseline-aligned td {&#xd;
			vertical-align: baseline;&#xd;
		}&#xd;
	&lt;/style&gt;&#xd;
&#xd;
	&lt;span style=&quot;float:right&quot;&gt;Paper Form ID: $paperFormId&lt;/span&gt;&#xd;
	&lt;h2&gt;Test Form (v0.1)&lt;/h2&gt;&#xd;
&#xd;
	&lt;section headerLabel=&quot;1. Encounter Details&quot;&gt;&#xd;
		&lt;table class=&quot;baseline-aligned&quot;&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Date:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;encounterDate default=&quot;today&quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Location:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;encounterLocation/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Provider:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;encounterProvider/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
		&lt;/table&gt;&#xd;
	&lt;/section&gt;&#xd;
&#xd;
	&lt;section headerLabel=&quot;2. Demographic Information&quot;&gt;&#xd;
		&lt;table class=&quot;baseline-aligned&quot;&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Name:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; expression=&quot;patient.personName&quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;ACTG Study ID:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; complexExpression=&quot;#foreach( $patId in $patientIdentifiers.get(&apos;ACTG Study ID&apos;) ) $patId #end &quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;AMRS Medical Record Number:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; complexExpression=&quot;#foreach( $patId in $patientIdentifiers.get(&apos;AMRS Medical Record Number&apos;) ) $patId #end &quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Gender:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; expression=&quot;patient.gender&quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Birthdate:&lt;/td&gt;&#xd;
				&lt;td&gt;&#xd;
					&lt;lookup class=&quot;value&quot; complexExpression=&quot;#if( \$patient.birthdateEstimated ) ~#end&quot;/&gt; &lt;lookup class=&quot;value&quot; expression=&quot;patient.birthdate&quot;/&gt;&#xd;
					(Age: &lt;lookup class=&quot;value&quot; expression=&quot;patient.age&quot;/&gt;)&#xd;
				&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Tribe:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; expression=&quot;personAttributes.get(&apos;Tribe&apos;)&quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;ANC NUMBER:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; expression=&quot;personAttributes.get(&apos;ANC NUMBER&apos;)&quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Birthplace:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; expression=&quot;personAttributes.get(&apos;Birthplace&apos;)&quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
			&lt;tr&gt;&#xd;
				&lt;td&gt;Citizenship:&lt;/td&gt;&#xd;
				&lt;td&gt;&lt;lookup class=&quot;value&quot; expression=&quot;personAttributes.get(&apos;Citizenship&apos;)&quot;/&gt;&lt;/td&gt;&#xd;
			&lt;/tr&gt;&#xd;
		&lt;/table&gt;&#xd;
	&lt;/section&gt;&#xd;
&#xd;
	&lt;submit/&gt;&#xd;
&#xd;
&lt;/htmlform&gt;</xmlDefinition>
</org.openmrs.module.htmlformentry.SerializableFormObject>