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Apr 25th, 2022
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  1. <?xml version="1.0" encoding="UTF-8"?>
  2. <PurcForm><Xform><xf:xforms xmlns:xf="http://www.w3.org/2002/xforms" xmlns:jr="http://openrosa.org/javarosa" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
  3. <xf:model>
  4. <xf:instance>
  5. <patient name="Patient" id="0" description-template="${/patient/family_name}$ ${/patient/middle_name}$ ${/patient/given_name}$">
  6. <enterer/>
  7. <family_name/>
  8. <middle_name/>
  9. <given_name/>
  10. <birth_date/>
  11. <birth_date_estimated/>
  12. <identifier/>
  13. <patient_id/>
  14. <gender/>
  15. <degree/>
  16. <family_name2/>
  17. <family_name_prefix/>
  18. <family_name_suffix/>
  19. <prefix/>
  20. <location_id>1</location_id>
  21. <patient_identifier_type_id>3</patient_identifier_type_id>
  22. <person_attribute2/>
  23. <person_attribute3/>
  24. <person_attribute5/>
  25. <person_attribute7/>
  26. <person_attribute6/>
  27. <person_attribute4/>
  28. <person_attribute1/>
  29. <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>
  30. <other_identifier/>
  31. <other_identifier_type_id/>
  32. <other_identifier_location_id/>
  33. </other_identifiers><person_attribute8/>
  34. <person_attribute9/>
  35. <person_attribute10/>
  36. <person_attribute11/>
  37. <person_attribute12/>
  38. <person_attribute13/>
  39. <person_attribute14/>
  40. <person_attribute15/>
  41. <person_attribute16/>
  42. <person_attribute17/>
  43. <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/>
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  59. <person_attribute35/>
  60.  
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  62.  
  63. <person_attribute39/>
  64. <person_attribute40/>
  65. <person_attribute41/>
  66. <person_attribute42/>
  67. <person_attribute43/>
  68. <person_attribute44/>
  69. <person_attribute45/>
  70. <person_attribute46/>
  71. <person_attribute47/>
  72. <person_attribute48/>
  73. <person_attribute49/>
  74. <person_attribute50/>
  75. <person_attribute51/>
  76. <person_attribute52/>
  77. <person_attribute53/>
  78. <person_attribute54/>
  79. <person_attribute55/>
  80. <person_attribute56/>
  81. <person_attribute57/>
  82. <person_attribute58/>
  83. <person_attribute59/>
  84. <person_attribute60/>
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  99. </patient>
  100. </xf:instance>
  101. <xf:bind id="family_name" nodeset="/patient/family_name" type="xsd:string" required="true()" constraint="length(.) &lt;= 20" message="The length of the field is more than the required, please check"/>
  102. <xf:bind id="middle_name" nodeset="/patient/middle_name" type="xsd:string" constraint="length(.) &lt;= 50" message="The length of the field is more than the required, please check"/>
  103. <xf:bind id="given_name" nodeset="/patient/given_name" type="xsd:string" required="true()" constraint="length(.) &lt;= 20" message="The length of the field is more than the required, please check"/>
  104. <xf:bind id="birth_date" nodeset="/patient/birth_date" type="xsd:date" required="true()"/>
  105. <xf:bind id="birth_date_estimated" nodeset="/patient/birth_date_estimated" type="xsd:boolean"/>
  106. <xf:bind id="identifier" nodeset="/patient/identifier" type="xsd:string" required="true()" constraint="length(.) &lt;= 20" message="Data out of range"/>
  107. <xf:bind id="patient_id" nodeset="/patient/patient_id" type="xsd:int" readonly="true()" visible="false()"/>
  108. <xf:bind id="gender" nodeset="/patient/gender" type="xsd:string" required="true()"/>
  109. <xf:bind id="degree" nodeset="/patient/degree" type="xsd:string" readonly="true()" visible="false()"/>
  110. <xf:bind id="family_name2" nodeset="/patient/family_name2" type="xsd:string" readonly="true()" visible="false()"/>
  111. <xf:bind id="family_name_prefix" nodeset="/patient/family_name_prefix" type="xsd:string" readonly="true()" visible="false()"/>
  112. <xf:bind id="family_name_suffix" nodeset="/patient/family_name_suffix" type="xsd:string" readonly="true()" visible="false()"/>
  113. <xf:bind id="prefix" nodeset="/patient/prefix" type="xsd:string" readonly="true()" visible="false()"/>
  114. <xf:bind id="location_id" nodeset="/patient/location_id" type="xsd:int" readonly="true()" visible="false()"/>
  115. <xf:bind id="patient_identifier_type_id" nodeset="/patient/patient_identifier_type_id" type="xsd:string" readonly="true()" visible="false()"/>
  116. <xf:bind id="person_attribute2" nodeset="/patient/person_attribute2" type="xsd:string" readonly="true()" visible="false()"/>
  117. <xf:bind id="person_attribute3" nodeset="/patient/person_attribute3" type="xsd:string" readonly="true()" visible="false()"/>
  118. <xf:bind id="person_attribute5" nodeset="/patient/person_attribute5" type="xsd:string" required="true()"/>
  119. <xf:bind id="person_attribute7" nodeset="/patient/person_attribute7" type="xsd:string" readonly="true()" visible="false()"/>
  120. <xf:bind id="person_attribute6" nodeset="/patient/person_attribute6" type="xsd:string" readonly="true()" visible="false()"/>
  121. <xf:bind id="person_attribute4" nodeset="/patient/person_attribute4" type="xsd:string" readonly="true()" visible="false()"/>
  122. <xf:bind id="person_attribute1" nodeset="/patient/person_attribute1" type="xsd:string" readonly="true()" visible="false()"/>
  123. <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" required="true()"/>
  124. <xf:bind id="person_attribute9" nodeset="/patient/person_attribute9" type="xsd:string" relevant="/patient/person_attribute8 = '5622'" action="enable" constraint="length(.) &lt;= 40" message="The length of the field is more than the required, please check" required="true()"/>
  125. <xf:bind id="person_attribute10" nodeset="/patient/person_attribute10" type="xsd:string" required="true()"/>
  126. <xf:bind id="person_attribute11" nodeset="/patient/person_attribute11" type="xsd:string" relevant="/patient/person_attribute10 = '5622'" action="enable" constraint="length(.) &lt;= 40" message="The length of the field is more than the required, please check" required="true()"/>
  127. <xf:bind id="person_attribute12" nodeset="/patient/person_attribute12" type="xsd:string" required="true()" constraint="length(.) &lt;= 40" message=""/>
  128. <xf:bind id="person_attribute13" nodeset="/patient/person_attribute13" type="xsd:string" required="true()" constraint="length(.) &lt;= 40" message=""/>
  129. <xf:bind id="person_attribute14" nodeset="/patient/person_attribute14" type="xsd:int" required="true()" constraint="length(.) &lt;= 10" message="Data out of range"/>
  130. <xf:bind id="person_attribute15" nodeset="/patient/person_attribute15" type="xsd:string" required="true()" constraint="length(.) &lt;= 50" message="The length of the field is more than the required, please check"/>
  131. <xf:bind id="person_attribute16" nodeset="/patient/person_attribute16" type="xsd:string" required="true()" constraint="length(.) &lt;= 50" message="The length of the field is more than the required, please check"/>
  132. <xf:bind id="person_attribute17" nodeset="/patient/person_attribute17" type="xsd:string" required="true()"/>
  133. <xf:bind id="person_attribute19" nodeset="/patient/person_attribute19" type="xsd:date"/><xf:bind id="person_attribute20" nodeset="/patient/person_attribute20" type="xsd:int" constraint="length(.) &lt;= 10" message="Data out of range"/><xf:bind id="person_attribute21" nodeset="/patient/person_attribute21" type="xsd:string" required="true()"/><xf:bind id="person_attribute22" nodeset="/patient/person_attribute22" type="xsd:string" required="true()"/><xf:bind id="person_attribute23" nodeset="/patient/person_attribute23" type="xsd:string" relevant="/patient/person_attribute22 = '1065'" action="enable" constraint="length(.) &lt;= 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" 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" required="true()" constraint="length(.) &lt;= 10" message="The length of the field is more than the required, please check"/><xf:bind id="person_attribute27" nodeset="/patient/person_attribute27" type="xsd:string" constraint="length(.) &lt;= 50" message="The length of the field is more than the required, please check"/><xf:bind id="person_attribute28" nodeset="/patient/person_attribute28" type="xsd:int" constraint="length(.) &lt;= 10" message="Data out of range"/><xf:bind id="person_attribute29" nodeset="/patient/person_attribute29" type="xsd:string" required="true()" constraint="length(.) &lt;= 12" message="The length of the field is more than the required, please check"/><xf:bind id="person_attribute31" nodeset="/patient/person_attribute31" type="xsd:string" required="true()"/><xf:bind id="person_attribute32" nodeset="/patient/person_attribute32" type="xsd:int" relevant="/patient/person_attribute31 = '1065'" action="enable" constraint=". &gt;= 1 and . &lt;= 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" required="true()"/><xf:bind id="person_attribute36" nodeset="/patient/person_attribute36" type="xsd:string" required="true()"/><xf:bind id="person_attribute37" nodeset="/patient/person_attribute37" type="xsd:string" required="true()"/><xf:bind id="person_attribute38" nodeset="/patient/person_attribute38" type="xsd:date" relevant="/patient/person_attribute37 = '161870' or /patient/person_attribute37 = '161871'" action="enable" constraint=". &lt;= 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"/>
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  149. <xf:bind id="person_attribute35" nodeset="/patient/person_attribute35" type="xsd:string"/>
  150.  
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  153. <xf:bind id="person_attribute39" nodeset="/patient/person_attribute39" type="xsd:string" relevant="/patient/person_attribute31 = '1065'" action="enable" required="false()"/>
  154. <xf:bind id="person_attribute40" nodeset="/patient/person_attribute40" type="xsd:string" required="true()"/>
  155. <xf:bind id="person_attribute41" nodeset="/patient/person_attribute41" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  156. <xf:bind id="person_attribute42" nodeset="/patient/person_attribute42" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  157. <xf:bind id="person_attribute43" nodeset="/patient/person_attribute43" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  158. <xf:bind id="person_attribute44" nodeset="/patient/person_attribute44" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  159. <xf:bind id="person_attribute45" nodeset="/patient/person_attribute45" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  160. <xf:bind id="person_attribute46" nodeset="/patient/person_attribute46" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  161. <xf:bind id="person_attribute47" nodeset="/patient/person_attribute47" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  162. <xf:bind id="person_attribute48" nodeset="/patient/person_attribute48" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  163. <xf:bind id="person_attribute49" nodeset="/patient/person_attribute49" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  164. <xf:bind id="person_attribute50" nodeset="/patient/person_attribute50" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 50" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  165. <xf:bind id="person_attribute51" nodeset="/patient/person_attribute51" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 30" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  166. <xf:bind id="person_attribute52" nodeset="/patient/person_attribute52" type="xsd:string" relevant="/patient/person_attribute40 = '1065'" action="enable" constraint="length(.) &lt;= 20" message="The length of the entered value is not correct, please enter correct value." required="false()"/>
  167. <xf:bind id="person_attribute53" nodeset="/patient/person_attribute53" type="xsd:string" required="true()"/>
  168. <xf:bind id="person_attribute54" nodeset="/patient/person_attribute54" type="xsd:boolean" required="true()"/>
  169. <xf:bind id="person_attribute55" nodeset="/patient/person_attribute55" type="xsd:string" required="true()"/>
  170. <xf:bind id="person_attribute56" nodeset="/patient/person_attribute56" type="xsd:string" required="true()"/>
  171. <xf:bind id="person_attribute57" nodeset="/patient/person_attribute57" type="xsd:boolean" required="true()"/>
  172. <xf:bind id="person_attribute58" nodeset="/patient/person_attribute58" type="xsd:string" relevant="/patient/person_attribute57 = true" action="enable" required="true()"/>
  173. <xf:bind id="person_attribute59" nodeset="/patient/person_attribute59" type="xsd:string" relevant="/patient/person_attribute58 = '162049'" action="enable" required="true()"/>
  174. <xf:bind id="person_attribute60" nodeset="/patient/person_attribute60" type="xsd:string" relevant="/patient/person_attribute37 = '161940'" action="enable" required="true()"/>
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  189. <xf:bind id="other_identifier" nodeset="/patient/other_identifiers/other_identifier" type="xsd:string"/>
  190. <xf:bind id="other_identifier_type_id" nodeset="/patient/other_identifiers/other_identifier_type_id" type="xsd:string" constraint="length(.) &lt;= 20" message=""/>
  191. <xf:bind id="other_identifier_location_id" nodeset="/patient/other_identifiers/other_identifier_location_id" type="xsd:string" constraint="length(.) &lt;= 12" message=""/>
  192. </xf:model>
  193. <xf:group id="1">
  194. <xf:label>Page1</xf:label>
  195. <xf:input bind="family_name">
  196. <xf:label>Last Name</xf:label>
  197. <xf:hint>The patient family name</xf:hint>
  198. </xf:input>
  199. <xf:input bind="middle_name">
  200. <xf:label>Middle name</xf:label>
  201. <xf:hint>The patient middle name</xf:hint>
  202. </xf:input>
  203. <xf:input bind="given_name">
  204. <xf:label>First Name</xf:label>
  205. <xf:hint>The patient given name</xf:hint>
  206. </xf:input>
  207. <xf:input bind="birth_date">
  208. <xf:label>Date of birth</xf:label>
  209. <xf:hint>The patient birth date</xf:hint>
  210. </xf:input>
  211. <xf:input bind="birth_date_estimated">
  212. <xf:label>Birth Date Estimated</xf:label>
  213. <xf:hint>Is the patient birth date estimated?</xf:hint>
  214. </xf:input>
  215. <xf:input bind="identifier">
  216. <xf:label>NACP number</xf:label>
  217. <xf:hint>The patient identifier</xf:hint>
  218. </xf:input>
  219. <xf:input bind="patient_id">
  220. <xf:label>Patient ID</xf:label>
  221. <xf:hint>The patient ID</xf:hint>
  222. </xf:input>
  223. <xf:select1 bind="gender">
  224. <xf:label>Gender</xf:label>
  225. <xf:hint>The patient's sex</xf:hint>
  226. <xf:item id="M">
  227. <xf:label>Male</xf:label>
  228. <xf:value>M</xf:value>
  229. </xf:item>
  230. <xf:item id="F">
  231. <xf:label>Female</xf:label>
  232. <xf:value>F</xf:value>
  233. </xf:item>
  234. </xf:select1>
  235. <xf:input bind="degree">
  236. <xf:label>Degree</xf:label>
  237. <xf:hint>The patient name degree</xf:hint>
  238. </xf:input>
  239. <xf:input bind="family_name2">
  240. <xf:label>Family Name 2</xf:label>
  241. <xf:hint>The patient second family name</xf:hint>
  242. </xf:input>
  243. <xf:input bind="family_name_prefix">
  244. <xf:label>Family Name Prefix</xf:label>
  245. <xf:hint>The patient family name prefix</xf:hint>
  246. </xf:input>
  247. <xf:input bind="family_name_suffix">
  248. <xf:label>Family Name Suffix</xf:label>
  249. <xf:hint>The patient family name suffix</xf:hint>
  250. </xf:input>
  251. <xf:input bind="prefix">
  252. <xf:label>Prefix</xf:label>
  253. <xf:hint>The patient name prefix</xf:hint>
  254. </xf:input>
  255. <xf:input bind="location_id">
  256. <xf:label>Location</xf:label>
  257. <xf:hint>The patient's location</xf:hint>
  258.  
  259. </xf:input>
  260. <xf:select1 bind="patient_identifier_type_id">
  261. <xf:label>Identifier Type</xf:label>
  262. <xf:hint>The patient's identifier type</xf:hint>
  263. <xf:item id="2">
  264. <xf:label>Old Identification Number</xf:label>
  265. <xf:value>2</xf:value>
  266. </xf:item><xf:item id="1">
  267. <xf:label>OpenMRS Identification Number</xf:label>
  268. <xf:value>1</xf:value>
  269. </xf:item><xf:item id="3">
  270. <xf:label>NACPNO</xf:label>
  271. <xf:value>3</xf:value>
  272. </xf:item>
  273.  
  274.  
  275. </xf:select1>
  276. <xf:input bind="person_attribute2">
  277. <xf:label>Birthplace</xf:label>
  278. <xf:hint>Location of persons birth</xf:hint>
  279. </xf:input>
  280. <xf:input bind="person_attribute3">
  281. <xf:label>Citizenship</xf:label>
  282. <xf:hint>Country of which this person is a member</xf:hint>
  283. </xf:input>
  284. <xf:select1 bind="person_attribute5">
  285. <xf:label>Civil Status</xf:label>
  286. <xf:hint>Marriage status of this person</xf:hint>
  287. <xf:item concept_id="1056" id="1056">
  288. <xf:label>SEPARATED</xf:label>
  289. <xf:value>1056</xf:value>
  290. </xf:item>
  291. <xf:item concept_id="1057" id="1057">
  292. <xf:label>NEVER MARRIED</xf:label>
  293. <xf:value>1057</xf:value>
  294. </xf:item>
  295. <xf:item concept_id="1058" id="1058">
  296. <xf:label>DIVORCED</xf:label>
  297. <xf:value>1058</xf:value>
  298. </xf:item>
  299. <xf:item concept_id="1059" id="1059">
  300. <xf:label>WIDOWED</xf:label>
  301. <xf:value>1059</xf:value>
  302. </xf:item>
  303. <xf:item concept_id="1060" id="1060">
  304. <xf:label>LIVING WITH PARTNER</xf:label>
  305. <xf:value>1060</xf:value>
  306. </xf:item>
  307. <xf:item concept_id="5555" id="5555">
  308. <xf:label>MARRIED</xf:label>
  309. <xf:value>5555</xf:value>
  310. </xf:item>
  311. <xf:item concept_id="5622" id="5622">
  312. <xf:label>OTHER NON-CODED</xf:label>
  313. <xf:value>5622</xf:value>
  314. </xf:item>
  315. </xf:select1>
  316. <xf:select1 bind="person_attribute7">
  317. <xf:label>Health Center</xf:label>
  318. <xf:hint>Specific Location of this person's home health center.</xf:hint>
  319. <xf:item id="1">
  320. <xf:label>Unknown Location [1]</xf:label>
  321. <xf:value>1</xf:value>
  322. </xf:item>
  323. </xf:select1>
  324. <xf:input bind="person_attribute6">
  325. <xf:label>Health District</xf:label>
  326. <xf:hint>District/region in which this patient' home health center resides</xf:hint>
  327. </xf:input>
  328. <xf:input bind="person_attribute4">
  329. <xf:label>Mother's Name</xf:label>
  330. <xf:hint>First or last name of this person's mother</xf:hint>
  331. </xf:input>
  332. <xf:input bind="person_attribute1">
  333. <xf:label>Race</xf:label>
  334. <xf:hint>Group of persons related by common descent or heredity</xf:hint>
  335. </xf:input>
  336. <xf:input bind="person_address_address1">
  337. <xf:label>Address 1</xf:label>
  338. </xf:input><xf:input bind="person_address_address2">
  339. <xf:label>Address 2</xf:label>
  340. </xf:input><xf:input bind="person_address_city_village">
  341. <xf:label>City/Village</xf:label>
  342. </xf:input><xf:input bind="person_address_state_province">
  343. <xf:label>State/Province</xf:label>
  344. </xf:input><xf:input bind="person_address_postal_code">
  345. <xf:label>Postal Code</xf:label>
  346. </xf:input><xf:input bind="person_address_country">
  347. <xf:label>Country</xf:label>
  348. </xf:input><xf:input bind="person_address_latitude">
  349. <xf:label>Latitude</xf:label>
  350. </xf:input><xf:input bind="person_address_longitude">
  351. <xf:label>Longitude</xf:label>
  352. </xf:input><xf:input bind="person_address_county_district">
  353. <xf:label>County/District</xf:label>
  354. </xf:input><xf:input bind="person_address_neighborhood_cell">
  355. <xf:label>Neighborhood Cell</xf:label>
  356. </xf:input><xf:input bind="person_address_region">
  357. <xf:label>Region</xf:label>
  358. </xf:input><xf:input bind="person_address_subregion">
  359. <xf:label>Sub Region</xf:label>
  360. </xf:input><xf:input bind="person_address_township_division">
  361. <xf:label>Township/Division</xf:label>
  362. </xf:input><xf:group id="other_identifiers">
  363. <xf:label>Other dentifiers</xf:label>
  364. <xf:repeat bind="other_identifiers">
  365. <xf:input bind="other_identifier">
  366. <xf:label>Identifier</xf:label>
  367. <xf:hint>The patient's other identifier value</xf:hint>
  368. </xf:input>
  369. <xf:select1 bind="other_identifier_type_id">
  370. <xf:label>Identifier Type</xf:label>
  371. <xf:hint>The patient's other identifier type</xf:hint>
  372. <xf:item id="2">
  373. <xf:label>Old Identification Number</xf:label>
  374. <xf:value>2</xf:value>
  375. </xf:item><xf:item id="1">
  376. <xf:label>OpenMRS Identification Number</xf:label>
  377. <xf:value>1</xf:value>
  378. </xf:item><xf:item id="3">
  379. <xf:label>NACPNO</xf:label>
  380. <xf:value>3</xf:value>
  381. </xf:item>
  382.  
  383.  
  384. </xf:select1>
  385. <xf:select1 bind="other_identifier_location_id">
  386. <xf:label>Identifier Location</xf:label>
  387. <xf:hint>The patient's other identifier location</xf:hint>
  388. <xf:item id="1">
  389. <xf:label>Unknown Location [1]</xf:label>
  390. <xf:value>1</xf:value>
  391. </xf:item>
  392. </xf:select1>
  393. </xf:repeat>
  394. </xf:group><xf:select1 bind="person_attribute8">
  395. <xf:label>District</xf:label>
  396. <xf:hint>this is the residence of the patient (district)</xf:hint>
  397. <xf:item concept_id="161002" id="161002">
  398. <xf:label>KILOMBERO</xf:label>
  399. <xf:value>161002</xf:value>
  400. </xf:item>
  401. <xf:item concept_id="161003" id="161003">
  402. <xf:label>KILOSA</xf:label>
  403. <xf:value>161003</xf:value>
  404. </xf:item>
  405. <xf:item concept_id="161004" id="161004">
  406. <xf:label>ULANGA</xf:label>
  407. <xf:value>161004</xf:value>
  408. </xf:item>
  409. <xf:item concept_id="5622" id="5622">
  410. <xf:label>OTHER NON-CODED</xf:label>
  411. <xf:value>5622</xf:value>
  412. </xf:item>
  413. </xf:select1>
  414. <xf:input bind="person_attribute9">
  415. <xf:label>Other distict(please specify)</xf:label>
  416. <xf:hint>other unspecified district</xf:hint>
  417. </xf:input>
  418. <xf:select1 bind="person_attribute10">
  419. <xf:label>Ward</xf:label>
  420. <xf:hint>residence of the patient(ward)</xf:hint>
  421. <xf:item concept_id="161005" id="161005">
  422. <xf:label>IDETE</xf:label>
  423. <xf:value>161005</xf:value>
  424. </xf:item>
  425. <xf:item concept_id="161006" id="161006">
  426. <xf:label>IFAKARA</xf:label>
  427. <xf:value>161006</xf:value>
  428. </xf:item>
  429. <xf:item concept_id="161007" id="161007">
  430. <xf:label>KIBAONI</xf:label>
  431. <xf:value>161007</xf:value>
  432. </xf:item>
  433. <xf:item concept_id="161008" id="161008">
  434. <xf:label>KIBEREGE</xf:label>
  435. <xf:value>161008</xf:value>
  436. </xf:item>
  437. <xf:item concept_id="161009" id="161009">
  438. <xf:label>KIDATU</xf:label>
  439. <xf:value>161009</xf:value>
  440. </xf:item>
  441. <xf:item concept_id="161010" id="161010">
  442. <xf:label>LUMEMO</xf:label>
  443. <xf:value>161010</xf:value>
  444. </xf:item>
  445. <xf:item concept_id="161011" id="161011">
  446. <xf:label>LUPIRO</xf:label>
  447. <xf:value>161011</xf:value>
  448. </xf:item>
  449. <xf:item concept_id="161012" id="161012">
  450. <xf:label>MANG'ULA</xf:label>
  451. <xf:value>161012</xf:value>
  452. </xf:item>
  453. <xf:item concept_id="161014" id="161014">
  454. <xf:label>MLIMBA</xf:label>
  455. <xf:value>161014</xf:value>
  456. </xf:item>
  457. <xf:item concept_id="161015" id="161015">
  458. <xf:label>MNGETA</xf:label>
  459. <xf:value>161015</xf:value>
  460. </xf:item>
  461. <xf:item concept_id="5622" id="5622">
  462. <xf:label>OTHER NON-CODED</xf:label>
  463. <xf:value>5622</xf:value>
  464. </xf:item>
  465. </xf:select1>
  466. <xf:input bind="person_attribute11">
  467. <xf:label>Other ward(please specify)</xf:label>
  468. <xf:hint>Other ward unspecified</xf:hint>
  469. </xf:input>
  470. <xf:input bind="person_attribute12">
  471. <xf:label>Village</xf:label>
  472. <xf:hint>residence of this patient(village)</xf:hint>
  473. </xf:input>
  474. <xf:input bind="person_attribute13">
  475. <xf:label>Street</xf:label>
  476. <xf:hint>residence of this patient(Street)</xf:hint>
  477. </xf:input>
  478. <xf:input bind="person_attribute14">
  479. <xf:label>Telephone number</xf:label>
  480. <xf:hint>telephone number of the patient</xf:hint>
  481. </xf:input>
  482. <xf:input bind="person_attribute15">
  483. <xf:label>10CELL_LEADER</xf:label>
  484. <xf:hint>10 cell leader name</xf:hint>
  485. </xf:input>
  486. <xf:input bind="person_attribute16">
  487. <xf:label>HEADD_HOUSEHOLD</xf:label>
  488. <xf:hint>Head household of the patient</xf:hint>
  489. </xf:input>
  490. <xf:select1 bind="person_attribute17">
  491. <xf:label>EDUCATION</xf:label>
  492. <xf:hint>highest education level of the patient</xf:hint>
  493. <xf:item concept_id="1107" id="1107">
  494. <xf:label>NONE</xf:label>
  495. <xf:value>1107</xf:value>
  496. </xf:item>
  497. <xf:item concept_id="1713" id="1713">
  498. <xf:label>PRIMARY SCHOOL EDUCATION</xf:label>
  499. <xf:value>1713</xf:value>
  500. </xf:item>
  501. <xf:item concept_id="1714" id="1714">
  502. <xf:label>SECONDARY SCHOOL EDUCATION</xf:label>
  503. <xf:value>1714</xf:value>
  504. </xf:item>
  505. <xf:item concept_id="159785" id="159785">
  506. <xf:label>college/university/polytechnic</xf:label>
  507. <xf:value>159785</xf:value>
  508. </xf:item>
  509. <xf:item concept_id="5622" id="5622">
  510. <xf:label>OTHER NON-CODED</xf:label>
  511. <xf:value>5622</xf:value>
  512. </xf:item>
  513. </xf:select1>
  514. <xf:input bind="person_attribute19">
  515. <xf:label>DATE_FIRST_POS</xf:label>
  516. <xf:hint>Date of first positive HIV test</xf:hint>
  517. </xf:input><xf:input bind="person_attribute20">
  518. <xf:label>VCT_NO</xf:label>
  519. <xf:hint>VCT number</xf:hint>
  520. </xf:input><xf:select1 bind="person_attribute21">
  521. <xf:label>HIVTYPE</xf:label>
  522. <xf:hint>HIV type</xf:hint>
  523. <xf:item concept_id="161017" id="161017">
  524. <xf:label>HIV type I</xf:label>
  525. <xf:value>161017</xf:value>
  526. </xf:item>
  527. <xf:item concept_id="161018" id="161018">
  528. <xf:label>HIV type II</xf:label>
  529. <xf:value>161018</xf:value>
  530. </xf:item>
  531. <xf:item concept_id="161019" id="161019">
  532. <xf:label>Both</xf:label>
  533. <xf:value>161019</xf:value>
  534. </xf:item>
  535. <xf:item concept_id="1067" id="1067">
  536. <xf:label>UNKNOWN</xf:label>
  537. <xf:value>1067</xf:value>
  538. </xf:item>
  539. </xf:select1><xf:select1 bind="person_attribute22">
  540. <xf:label>COMM_SUPPORT</xf:label>
  541. <xf:hint>community support</xf:hint>
  542. <xf:item concept_id="1065" id="1065">
  543. <xf:label>YES</xf:label>
  544. <xf:value>1065</xf:value>
  545. </xf:item>
  546. <xf:item concept_id="1066" id="1066">
  547. <xf:label>NO</xf:label>
  548. <xf:value>1066</xf:value>
  549. </xf:item>
  550. </xf:select1><xf:input bind="person_attribute23">
  551. <xf:label>SUPPORT_GROUP</xf:label>
  552. <xf:hint>support group</xf:hint>
  553. </xf:input><xf:select bind="person_attribute24">
  554. <xf:label>PAT_REF</xf:label>
  555. <xf:hint>patient referral source</xf:hint>
  556. <xf:item concept_id="160542" id="160542">
  557. <xf:label>Outpatient department</xf:label>
  558. <xf:value>160542</xf:value>
  559. </xf:item>
  560. <xf:item concept_id="161020" id="161020">
  561. <xf:label>PLHIV group</xf:label>
  562. <xf:value>161020</xf:value>
  563. </xf:item>
  564. <xf:item concept_id="160546" id="160546">
  565. <xf:label>Sexually transmitted infection program/clinic</xf:label>
  566. <xf:value>160546</xf:value>
  567. </xf:item>
  568. <xf:item concept_id="161039" id="161039">
  569. <xf:label>HBC</xf:label>
  570. <xf:value>161039</xf:value>
  571. </xf:item><xf:item concept_id="161021" id="161021">
  572. <xf:label>RCH/PMTCT/EID</xf:label>
  573. <xf:value>161021</xf:value>
  574. </xf:item><xf:item concept_id="5485" id="5485">
  575. <xf:label>Inpatient</xf:label>
  576. <xf:value>5485</xf:value>
  577. </xf:item><xf:item concept_id="5487" id="5487">
  578. <xf:label>Tuberculosis Treatment or DOT Program</xf:label>
  579. <xf:value>5487</xf:value>
  580. </xf:item><xf:item concept_id="160539" id="160539">
  581. <xf:label>Voluntary counseling and testing program</xf:label>
  582. <xf:value>160539</xf:value>
  583. </xf:item><xf:item concept_id="5622" id="5622">
  584. <xf:label>OTHER NON-CODED</xf:label>
  585. <xf:value>5622</xf:value>
  586. </xf:item>
  587.  
  588.  
  589.  
  590.  
  591.  
  592.  
  593. <xf:item 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:input bind="person_attribute25">
  594. <xf:label>OTHER_PATREF</xf:label>
  595. <xf:hint>Other source of referral not specified</xf:hint>
  596. </xf:input><xf:input bind="person_attribute26">
  597. <xf:label>TELNO_HH</xf:label>
  598. <xf:hint>telephone number of head household of the patient</xf:hint>
  599. </xf:input><xf:input bind="person_attribute27">
  600. <xf:label>TXT_SUPPORTER</xf:label>
  601. <xf:hint>Name of treatment support of this patient</xf:hint>
  602. </xf:input><xf:input bind="person_attribute28">
  603. <xf:label>TELNO_TXTSUPP</xf:label>
  604. <xf:hint>telephone number of treatment supporter of this patient</xf:hint>
  605. </xf:input><xf:input bind="person_attribute29">
  606. <xf:label>DSS_NO</xf:label>
  607. <xf:hint>DSS number</xf:hint>
  608. </xf:input><xf:select1 bind="person_attribute31">
  609. <xf:label>CHILDREN</xf:label>
  610. <xf:hint>This patient has children?</xf:hint>
  611. <xf:item concept_id="1065" id="1065">
  612. <xf:label>YES</xf:label>
  613. <xf:value>1065</xf:value>
  614. </xf:item>
  615. <xf:item concept_id="1066" id="1066">
  616. <xf:label>NO</xf:label>
  617. <xf:value>1066</xf:value>
  618. </xf:item>
  619. </xf:select1><xf:input bind="person_attribute32">
  620. <xf:label>NO_CHILD</xf:label>
  621. <xf:hint>number of children</xf:hint>
  622. </xf:input><xf:input bind="person_attribute33">
  623. <xf:label>DOB_LAST_CHILD</xf:label>
  624. <xf:hint>Date of birth of the last children</xf:hint>
  625. </xf:input><xf:select1 bind="person_attribute34">
  626. <xf:label>OCCUPATION</xf:label>
  627. <xf:hint>Occupation of this patient</xf:hint>
  628. <xf:item concept_id="1538" id="1538">
  629. <xf:label>FARMER</xf:label>
  630. <xf:value>1538</xf:value>
  631. </xf:item>
  632. <xf:item concept_id="159465" id="159465">
  633. <xf:label>Student</xf:label>
  634. <xf:value>159465</xf:value>
  635. </xf:item>
  636. <xf:item concept_id="161457" id="161457">
  637. <xf:label>Employee-private</xf:label>
  638. <xf:value>161457</xf:value>
  639. </xf:item>
  640. <xf:item concept_id="161013" id="161013">
  641. <xf:label>Employee-government</xf:label>
  642. <xf:value>161013</xf:value>
  643. </xf:item>
  644. <xf:item concept_id="161016" id="161016">
  645. <xf:label>self-employed</xf:label>
  646. <xf:value>161016</xf:value>
  647. </xf:item>
  648. <xf:item concept_id="123801" id="123801">
  649. <xf:label>Unemployed</xf:label>
  650. <xf:value>123801</xf:value>
  651. </xf:item>
  652. <xf:item concept_id="160295" id="160295">
  653. <xf:label>Housewife</xf:label>
  654. <xf:value>160295</xf:value>
  655. </xf:item>
  656. <xf:item concept_id="159461" id="159461">
  657. <xf:label>Retired</xf:label>
  658. <xf:value>159461</xf:value>
  659. </xf:item>
  660. <xf:item concept_id="5622" id="5622">
  661. <xf:label>OTHER NON-CODED</xf:label>
  662. <xf:value>5622</xf:value>
  663. </xf:item>
  664. </xf:select1><xf:select bind="person_attribute36">
  665. <xf:label>TRANSFER_IN</xf:label>
  666. <xf:hint>Transfer in(select all that apply)</xf:hint>
  667. <xf:item concept_id="1175" id="1175">
  668. <xf:label>NOT APPLICABLE</xf:label>
  669. <xf:value>1175</xf:value>
  670. </xf:item>
  671. <xf:item concept_id="161049" id="161049">
  672. <xf:label>with records(referral and CTC 1 forms)</xf:label>
  673. <xf:value>161049</xf:value>
  674. </xf:item>
  675. <xf:item concept_id="161050" id="161050">
  676. <xf:label>No records available</xf:label>
  677. <xf:value>161050</xf:value>
  678. </xf:item>
  679. <xf:item concept_id="161051" id="161051">
  680. <xf:label>In care</xf:label>
  681. <xf:value>161051</xf:value>
  682. </xf:item>
  683. <xf:item concept_id="161052" id="161052">
  684. <xf:label>On ART</xf:label>
  685. <xf:value>161052</xf:value>
  686. </xf:item>
  687. </xf:select><xf:select1 bind="person_attribute37">
  688. <xf:label>CONSENT</xf:label>
  689. <xf:hint>informed consent patient signed</xf:hint>
  690. <xf:item concept_id="161053" id="161053">
  691. <xf:label>No. but ask again later</xf:label>
  692. <xf:value>161053</xf:value>
  693. </xf:item>
  694. <xf:item concept_id="161054" id="161054">
  695. <xf:label>No, the patient refused</xf:label>
  696. <xf:value>161054</xf:value>
  697. </xf:item>
  698. <xf:item concept_id="161869" id="161869">
  699. <xf:label>Form given to take home</xf:label>
  700. <xf:value>161869</xf:value>
  701. </xf:item>
  702. <xf:item concept_id="161870" id="161870">
  703. <xf:label>Yes, given today</xf:label>
  704. <xf:value>161870</xf:value>
  705. </xf:item>
  706. <xf:item concept_id="161871" id="161871">
  707. <xf:label>Yes, and consent use of data since baseline</xf:label>
  708. <xf:value>161871</xf:value>
  709. </xf:item>
  710. <xf:item concept_id="161939" id="161939">
  711. <xf:label>No, Patient too sick to be asked</xf:label>
  712. <xf:value>161939</xf:value>
  713. </xf:item>
  714. <xf:item concept_id="161940" id="161940">
  715. <xf:label>Not signed for other reason</xf:label>
  716. <xf:value>161940</xf:value>
  717. </xf:item>
  718. </xf:select1><xf:input bind="person_attribute38">
  719. <xf:label>DATE_CONSENT</xf:label>
  720. <xf:hint>Date of informed consent</xf:hint>
  721. </xf:input><xf:input bind="person_attribute18">
  722. <xf:label>EDU_OTHER</xf:label>
  723. <xf:hint>Other education level</xf:hint>
  724. </xf:input>
  725.  
  726.  
  727.  
  728.  
  729.  
  730.  
  731.  
  732.  
  733.  
  734.  
  735.  
  736.  
  737.  
  738.  
  739.  
  740. <xf:input bind="person_attribute35">
  741. <xf:label>OCCUP_OTHER</xf:label>
  742. <xf:hint>Occupation of this patient</xf:hint>
  743. </xf:input>
  744.  
  745.  
  746.  
  747. <xf:select1 bind="person_attribute39">
  748. <xf:label>CHILDREN_LESS16</xf:label>
  749. <xf:hint>Any children who are &lt;16 years of age</xf:hint>
  750. <xf:item concept_id="1066" id="1066">
  751. <xf:label>NO</xf:label>
  752. <xf:value>1066</xf:value>
  753. </xf:item>
  754. <xf:item concept_id="1065" id="1065">
  755. <xf:label>YES</xf:label>
  756. <xf:value>1065</xf:value>
  757. </xf:item>
  758. </xf:select1>
  759. <xf:select1 bind="person_attribute40">
  760. <xf:label>FAMILY_CDCI</xf:label>
  761. <xf:hint>Any family members attending CDCI?</xf:hint>
  762. <xf:item concept_id="1066" id="1066">
  763. <xf:label>NO</xf:label>
  764. <xf:value>1066</xf:value>
  765. </xf:item>
  766. <xf:item concept_id="1065" id="1065">
  767. <xf:label>YES</xf:label>
  768. <xf:value>1065</xf:value>
  769. </xf:item>
  770. <xf:item concept_id="1067" id="1067">
  771. <xf:label>UNKNOWN</xf:label>
  772. <xf:value>1067</xf:value>
  773. </xf:item>
  774. </xf:select1>
  775. <xf:input bind="person_attribute41">
  776. <xf:label>FAMILY_NAME1</xf:label>
  777. <xf:hint>Name of 1st family member</xf:hint>
  778. </xf:input>
  779. <xf:input bind="person_attribute42">
  780. <xf:label>FAMILY_RELATION1</xf:label>
  781. <xf:hint>Relationship of 1st family member</xf:hint>
  782. </xf:input>
  783. <xf:input bind="person_attribute43">
  784. <xf:label>FAMILY_NACP1</xf:label>
  785. <xf:hint>NACPNO for 1st family member</xf:hint>
  786. </xf:input>
  787. <xf:input bind="person_attribute44">
  788. <xf:label>FAMILY_NAME2</xf:label>
  789. <xf:hint>Name of 2nd family member</xf:hint>
  790. </xf:input>
  791. <xf:input bind="person_attribute45">
  792. <xf:label>FAMILY_RELATION2</xf:label>
  793. <xf:hint>Relationship of 2ND family member</xf:hint>
  794. </xf:input>
  795. <xf:input bind="person_attribute46">
  796. <xf:label>FAMILY_NACP2</xf:label>
  797. <xf:hint>NACPNO for 2ND family member</xf:hint>
  798. </xf:input>
  799. <xf:input bind="person_attribute47">
  800. <xf:label>FAMILY_NAME3</xf:label>
  801. <xf:hint>Name of 3RD family member</xf:hint>
  802. </xf:input>
  803. <xf:input bind="person_attribute48">
  804. <xf:label>FAMILY_RELATION3</xf:label>
  805. <xf:hint>Relationship of 3RD family member</xf:hint>
  806. </xf:input>
  807. <xf:input bind="person_attribute49">
  808. <xf:label>FAMILY_NACP3</xf:label>
  809. <xf:hint>NACPNO for 3RD family member</xf:hint>
  810. </xf:input>
  811. <xf:input bind="person_attribute50">
  812. <xf:label>FAMILY_NAME4</xf:label>
  813. <xf:hint>Name of 4TH family member</xf:hint>
  814. </xf:input>
  815. <xf:input bind="person_attribute51">
  816. <xf:label>FAMILY_RELATION4</xf:label>
  817. <xf:hint>Relationship of 4TH family member</xf:hint>
  818. </xf:input>
  819. <xf:input bind="person_attribute52">
  820. <xf:label>FAMILY_NACP4</xf:label>
  821. <xf:hint>NACPNO for 4TH family member</xf:hint>
  822. </xf:input>
  823. <xf:input bind="person_attribute53">
  824. <xf:label>NICK_NAME</xf:label>
  825. <xf:hint>A well known name of a client</xf:hint>
  826. </xf:input>
  827. <xf:input bind="person_attribute54">
  828. <xf:label>Birth Date Estimated</xf:label>
  829. <xf:hint>Is the patient birth date estimated?</xf:hint>
  830. </xf:input>
  831. <xf:input bind="person_attribute55">
  832. <xf:label>TB_NO</xf:label>
  833. <xf:hint>Unique identification number of tb patient</xf:hint>
  834. </xf:input>
  835. <xf:input bind="person_attribute56">
  836. <xf:label>CBHS_NO</xf:label>
  837. <xf:hint>CBHS number</xf:hint>
  838. </xf:input>
  839. <xf:input bind="person_attribute57">
  840. <xf:label>HEALTH_INSURANCE</xf:label>
  841. <xf:hint>Do you have health insurance?</xf:hint>
  842. </xf:input>
  843. <xf:select1 bind="person_attribute58">
  844. <xf:label>HEALTH_INSURANCE_TYPE</xf:label>
  845. <xf:hint>Type of health insurance scheme</xf:hint>
  846. <xf:item concept_id="162044" id="162044">
  847. <xf:label>NHIF</xf:label>
  848. <xf:value>162044</xf:value>
  849. </xf:item>
  850. <xf:item concept_id="162045" id="162045">
  851. <xf:label>SHIB_NSSF</xf:label>
  852. <xf:value>162045</xf:value>
  853. </xf:item>
  854. <xf:item concept_id="162046" id="162046">
  855. <xf:label>CHF</xf:label>
  856. <xf:value>162046</xf:value>
  857. </xf:item>
  858. <xf:item concept_id="162047" id="162047">
  859. <xf:label>TIKA</xf:label>
  860. <xf:value>162047</xf:value>
  861. </xf:item>
  862. <xf:item concept_id="162048" id="162048">
  863. <xf:label>AAR</xf:label>
  864. <xf:value>162048</xf:value>
  865. </xf:item>
  866. <xf:item concept_id="162049" id="162049">
  867. <xf:label>OTHER_HEALTH_INSURANCE</xf:label>
  868. <xf:value>162049</xf:value>
  869. </xf:item>
  870. </xf:select1>
  871. <xf:input bind="person_attribute59">
  872. <xf:label>OTHER_HEALTH_INSURANCE_SPECIFY</xf:label>
  873. <xf:hint>Other health insurance specify</xf:hint>
  874. </xf:input>
  875. <xf:input bind="person_attribute60">
  876. <xf:label>CONSENT_OTHER</xf:label>
  877. <xf:hint>Other reasons for not signing consent form</xf:hint>
  878. </xf:input>
  879.  
  880.  
  881.  
  882.  
  883.  
  884.  
  885.  
  886.  
  887.  
  888.  
  889.  
  890.  
  891.  
  892.  
  893. </xf:group>
  894. </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="2407px" 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, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="GroupBox" Binding="LEFT48pxTOP100px" Left="48px" Top="100px" Width="820px" Height="2264px" TabIndex="0" fontWeight="normal" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="rgb(26, 172, 155)" textAlign="center" HeaderLabel="true"/><Item WidgetType="Label" Text="NACP Number" HelpText="The patient identifier" Binding="identifier" Left="8px" Top="41px" Width="100px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="First name" HelpText="The patient given name" Binding="given_name" Left="9px" Top="88px" Width="100px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Occupation" HelpText="Occupation of this patient" Binding="person_attribute34" Left="15px" Top="755px" Height="28px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute34" Left="465px" Top="782px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Retired" HelpText="Retired" Binding="159461" ParentBinding="person_attribute34" Left="328px" Top="783px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Housewife" HelpText="Housewife" Binding="160295" ParentBinding="person_attribute34" Left="225px" Top="782px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Unemployed" HelpText="Unemployed" Binding="123801" ParentBinding="person_attribute34" Left="106px" Top="783px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Farmer" HelpText="FARMER" Binding="1538" ParentBinding="person_attribute34" Left="106px" Top="753px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Student" HelpText="Student" Binding="159465" ParentBinding="person_attribute34" Left="225px" Top="753px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Employee-private" HelpText="Employee-private" Binding="161457" ParentBinding="person_attribute34" Left="329px" Top="752px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Employee-government" HelpText="Employee-government" Binding="161013" ParentBinding="person_attribute34" Left="465px" Top="753px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute17" Left="465px" Top="852px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="College/University" HelpText="college/university/polytechnic" Binding="159785" ParentBinding="person_attribute17" Left="225px" Top="852px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Primary school education" HelpText="PRIMARY SCHOOL EDUCATION" Binding="1713" ParentBinding="person_attribute17" Left="325px" Top="816px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="None" HelpText="NONE" Binding="1107" ParentBinding="person_attribute17" Left="225px" Top="816px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Self-employed" HelpText="self-employed" Binding="161016" ParentBinding="person_attribute34" Left="672px" Top="755px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Secondary school education" HelpText="SECONDARY SCHOOL EDUCATION" Binding="1714" ParentBinding="person_attribute17" Left="523px" Top="817px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP620px" Left="0px" Top="738px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="Children" HelpText="This patient has children?" Binding="person_attribute31" Left="10px" Top="705px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute31" Left="134px" Top="707px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute31" Left="87px" Top="705px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Any children who are &lt;18 years of age" HelpText="Any children who are &lt;16 years of age" Binding="person_attribute39" Left="439px" Top="707px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute39" Left="704px" Top="704px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute39" Left="749px" Top="704px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Number of children" HelpText="number of children" Binding="person_attribute32" Left="205px" Top="709px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP449px" Left="0px" Top="503px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="Name of head of household" HelpText="Head household of the patient" Binding="person_attribute16" Left="12px" Top="391px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="451px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="394px" Width="300px" Height="13px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="telephone number of treatment supporter of this patient" Binding="person_attribute28" Left="646px" Top="467px" Width="159px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="450px" Height="1px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP333px" Left="0px" Top="382px" Width="821px" Height="1px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="Street" HelpText="residence of this patient(Street)" Binding="person_attribute13" Left="578px" Top="315px" Height="0px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 10 cell leader" HelpText="10 cell leader name" Binding="person_attribute15" Left="360px" Top="354px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP249px" Left="0px" Top="302px" Width="820px" Height="1px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="Ward" HelpText="residence of the patient(ward)" Binding="person_attribute10" Left="10px" Top="247px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Specify" HelpText="Label" Binding="LEFT384pxTOP222px" Left="570px" Top="273px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute10" Left="470px" Top="270px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kidatu" HelpText="KIDATU" Binding="161009" ParentBinding="person_attribute10" Left="470px" Top="243px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Mngeta" HelpText="MNGETA" Binding="161015" ParentBinding="person_attribute10" Left="370px" Top="273px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kiberege" HelpText="KIBEREGE" Binding="161008" ParentBinding="person_attribute10" Left="370px" Top="243px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Mlimba" HelpText="MLIMBA" Binding="161014" ParentBinding="person_attribute10" Left="270px" Top="273px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kibaoni" HelpText="KIBAONI" Binding="161007" ParentBinding="person_attribute10" Left="270px" Top="244px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Mang'ula" HelpText="MANG'ULA" Binding="161012" ParentBinding="person_attribute10" Left="170px" Top="271px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Ifakara" HelpText="IFAKARA" Binding="161006" ParentBinding="person_attribute10" Left="170px" Top="244px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Lupiro" HelpText="LUPIRO" Binding="161011" ParentBinding="person_attribute10" Left="70px" Top="274px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Idete" HelpText="IDETE" Binding="161005" ParentBinding="person_attribute10" Left="70px" Top="246px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Lumemo" HelpText="LUMEMO" Binding="161010" ParentBinding="person_attribute10" Left="620px" Top="239px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP179px" Left="0px" Top="235px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="District" HelpText="this is the residence of the patient (district)" Binding="person_attribute8" Left="11px" Top="204px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Specify" HelpText="Label" Binding="LEFT508pxTOP155px" Left="571px" Top="206px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute8" Left="371px" Top="204px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Ulanga" HelpText="ULANGA" Binding="161004" ParentBinding="person_attribute8" Left="271px" Top="205px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kilosa" HelpText="KILOSA" Binding="161003" ParentBinding="person_attribute8" Left="171px" Top="203px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Kilombero" HelpText="KILOMBERO" Binding="161002" ParentBinding="person_attribute8" Left="71px" Top="203px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP139px" Left="0px" Top="190px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="Last name" HelpText="The patient family name" Binding="family_name" Left="569px" Top="77px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Middle Name(s)" HelpText="The patient middle name" Binding="middle_name" Left="255px" Top="77px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Unknown" HelpText="UNKNOWN" Binding="1067" ParentBinding="person_attribute40" Left="376px" Top="1747px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Any family members attending CDCI?" HelpText="Any family members attending CDCI?" Binding="person_attribute40" Left="17px" Top="1752px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute40" Left="323px" Top="1748px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute40" Left="275px" Top="1748px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 1st family member" HelpText="Name of 1st family member" Binding="person_attribute41" Left="19px" Top="1791px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 1st family member" HelpText="Relationship of 1st family member" Binding="person_attribute42" Left="21px" Top="1833px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 1st family member" HelpText="NACPNO for 1st family member" Binding="person_attribute43" Left="19px" Top="1871px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 2nd family member" HelpText="Name of 2nd family member" Binding="person_attribute44" Left="19px" Top="1910px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 2nd family member" HelpText="Relationship of 2ND family member" Binding="person_attribute45" Left="19px" Top="1952px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 2nd family member" HelpText="NACPNO for 2ND family member" Binding="person_attribute46" Left="19px" Top="1989px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 3rd family member" HelpText="Name of 3RD family member" Binding="person_attribute47" Left="19px" Top="2032px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 3rd family member" HelpText="Relationship of 3RD family member" Binding="person_attribute48" Left="19px" Top="2073px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 3rd family member" HelpText="NACPNO for 3RD family member" Binding="person_attribute49" Left="20px" Top="2114px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Name of 4th family member" HelpText="Name of 4TH family member" Binding="person_attribute50" Left="19px" Top="2154px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Relationship of 4th family member" HelpText="Relationship of 4TH family member" Binding="person_attribute51" Left="19px" Top="2189px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="NACPNO for 4th family member" HelpText="NACPNO for 4TH family member" Binding="person_attribute52" Left="20px" Top="2233px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP449px" Left="0px" Top="1737px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="DatePicker" HelpText="Date of informed consent" Binding="person_attribute38" Left="243px" Top="1704px" Width="215px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="1632px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP1168px" Left="0px" Top="1584px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="CheckBox" Text="On ART" HelpText="On ART" Binding="161052" ParentBinding="person_attribute36" Left="706px" Top="1512px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="Not applicable" HelpText="NOT APPLICABLE" Binding="1175" ParentBinding="person_attribute36" Left="236px" Top="1509px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><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="1548px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="No records available" HelpText="No records available" Binding="161050" ParentBinding="person_attribute36" Left="528px" Top="1510px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="In care" HelpText="In care" Binding="161051" ParentBinding="person_attribute36" Left="529px" Top="1549px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP1131px" Left="0px" Top="1492px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="CheckBox" Text="PLHIV group" HelpText="PLHIV group" Binding="161020" ParentBinding="person_attribute24" Left="258px" Top="1422px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="HBC" HelpText="HBC" Binding="161039" ParentBinding="person_attribute24" Left="258px" Top="1362px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="RCH/PMTCT/EID" HelpText="RCH/PMTCT/EID" Binding="161021" ParentBinding="person_attribute24" Left="478px" Top="1392px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="STI program/clinic" HelpText="Sexually transmitted infection program/clinic" Binding="160546" ParentBinding="person_attribute24" Left="478px" Top="1362px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="OPD" HelpText="Outpatient department" Binding="160542" ParentBinding="person_attribute24" Left="258px" Top="1337px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="1337px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="Other, specify" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute24" Left="259px" Top="1452px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP925px" Left="0px" Top="1297px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP834px" Left="0px" Top="1208px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="Date of first positive HIV test" HelpText="Date of first positive HIV test" Binding="person_attribute19" Left="12px" Top="1134px" Height="21px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="HIV type" HelpText="HIV type" Binding="person_attribute21" Left="12px" Top="1173px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="VCT number(SFRH only)" HelpText="VCT number" Binding="person_attribute20" Left="460px" Top="1139px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" textDecoration="none"/><Item WidgetType="RadioButton" Text="Unknown" HelpText="UNKNOWN" Binding="1067" ParentBinding="person_attribute21" Left="612px" Top="1171px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Both" HelpText="Both" Binding="161019" ParentBinding="person_attribute21" Left="462px" Top="1170px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="HIV type II" HelpText="HIV type II" Binding="161018" ParentBinding="person_attribute21" Left="322px" Top="1169px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="HIV type I" HelpText="HIV type I" Binding="161017" ParentBinding="person_attribute21" Left="222px" Top="1169px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP759px" Left="0px" Top="1113px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP759px" Left="0px" Top="875px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" HelpText="Label" Binding="LEFT0pxTOP449px" Left="0px" Top="685px" Width="820px" Height="2px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" backgroundColor="black"/><Item WidgetType="Label" Text="Marital status" HelpText="Marriage status of this person" Binding="person_attribute5" Left="18px" Top="627px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other" HelpText="OTHER NON-CODED" Binding="5622" ParentBinding="person_attribute5" Left="401px" Top="657px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Separated" HelpText="SEPARATED" Binding="1056" ParentBinding="person_attribute5" Left="571px" Top="627px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Living with partner" HelpText="LIVING WITH PARTNER" Binding="1060" ParentBinding="person_attribute5" Left="401px" Top="627px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Widowed" HelpText="WIDOWED" Binding="1059" ParentBinding="person_attribute5" Left="301px" Top="657px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Married" HelpText="MARRIED" Binding="5555" ParentBinding="person_attribute5" Left="301px" Top="627px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Divorced" HelpText="DIVORCED" Binding="1058" ParentBinding="person_attribute5" Left="171px" Top="657px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Never married" HelpText="NEVER MARRIED" Binding="1057" ParentBinding="person_attribute5" Left="170px" Top="627px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Date of birth" HelpText="The patient birth date" Binding="birth_date" Left="239px" Top="562px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="DatePicker" HelpText="The patient birth date" Binding="birth_date" Left="240px" Top="586px" Width="167px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="DSS number" HelpText="DSS number" Binding="person_attribute29" Left="12px" Top="566px" Height="2px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="National Health Insurance Fund (NHIF)" HelpText="NHIF" Binding="162044" ParentBinding="person_attribute58" Left="256px" Top="934px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Community Health Fund (CHF)" HelpText="CHF" Binding="162046" ParentBinding="person_attribute58" Left="576px" Top="976px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Tiba Kwa Kadi (TIKA)" HelpText="TIKA" Binding="162047" ParentBinding="person_attribute58" Left="575px" Top="935px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="NSSF Social Health Insurance Benefit (SHIB)" HelpText="SHIB_NSSF" Binding="162045" ParentBinding="person_attribute58" Left="255px" Top="974px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Other Health Insurance" HelpText="OTHER_HEALTH_INSURANCE" Binding="162049" ParentBinding="person_attribute58" Left="255px" Top="1015px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="AAR" HelpText="AAR" Binding="162048" ParentBinding="person_attribute58" Left="576px" Top="1015px" TabIndex="0" fontWeight="normal" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Other health insurance specify" HelpText="Other health insurance specify" Binding="person_attribute59" Left="18px" Top="1063px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="Yes" Binding="true" ParentBinding="person_attribute57" Left="266px" Top="893px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="No" Binding="false" ParentBinding="person_attribute57" Left="348px" Top="894px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Do you have health insurance?" HelpText="Do you have health insurance?" Binding="person_attribute57" Left="15px" Top="896px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Patient joined community support organization" HelpText="community support" Binding="person_attribute22" Left="8px" Top="1222px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="NO" Binding="1066" ParentBinding="person_attribute22" Left="453px" Top="1224px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="YES" Binding="1065" ParentBinding="person_attribute22" Left="535px" Top="1225px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="Yes" Binding="true" ParentBinding="person_attribute54" Left="481px" Top="591px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="No" HelpText="No" Binding="false" ParentBinding="person_attribute54" Left="567px" Top="592px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Female" HelpText="Female" Binding="F" ParentBinding="gender" Left="732px" Top="592px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Male" HelpText="Male" Binding="M" ParentBinding="gender" Left="665px" Top="593px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Birth Date Estimated" HelpText="Is the patient birth date estimated?" Binding="person_attribute54" Left="474px" Top="569px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Sex" HelpText="The patient's sex" Binding="gender" Left="675px" Top="567px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="CBHS Number" HelpText="CBHS number" Binding="person_attribute56" Left="430px" Top="517px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="TB Number" HelpText="Unique identification number of tb patient" Binding="person_attribute55" Left="17px" Top="517px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Other reasons specify" HelpText="Other reasons for not signing consent form" Binding="person_attribute60" Left="14px" Top="1671px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Date of informed consent" HelpText="Date of informed consent" Binding="person_attribute38" Left="14px" Top="1706px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Nick name" HelpText="A well known name of a client" Binding="person_attribute53" Left="19px" Top="156px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Name of organization/group" HelpText="support group" Binding="person_attribute23" Left="9px" Top="1265px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 1st family member" Binding="person_attribute42" Left="255px" Top="1833px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 1st family member" Binding="person_attribute43" Left="255px" Top="1869px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 2nd family member" Binding="person_attribute44" Left="255px" Top="1909px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 2ND family member" Binding="person_attribute45" Left="255px" Top="1949px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 2ND family member" Binding="person_attribute46" Left="256px" Top="1990px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 3RD family member" Binding="person_attribute47" Left="255px" Top="2029px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 3RD family member" Binding="person_attribute48" Left="255px" Top="2069px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 3RD family member" Binding="person_attribute49" Left="256px" Top="2109px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 4TH family member" Binding="person_attribute50" Left="255px" Top="2147px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Relationship of 4TH family member" Binding="person_attribute51" Left="255px" Top="2189px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="NACPNO for 4TH family member" Binding="person_attribute52" Left="256px" Top="2230px" Width="250px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="Inpatient care hospitalization" HelpText="INPATIENT CARE OR HOSPITALIZATION" Binding="5485" ParentBinding="person_attribute24" Left="258px" Top="1392px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="CheckBox" Text="Self referral and VCT" HelpText="Self-referral" Binding="160551" ParentBinding="person_attribute24" Left="481px" Top="1421px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient identifier" Binding="identifier" Left="125px" Top="36px" Width="412px" Height="31px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient given name" Binding="given_name" Left="10px" Top="110px" Width="221px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient middle name" Binding="middle_name" Left="255px" Top="109px" Width="298px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="The patient family name" Binding="family_name" Left="570px" Top="106px" Width="228px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="A well known name of a client" Binding="person_attribute53" Left="106px" Top="152px" Width="446px" Height="25px" TabIndex="189" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="other unspecified district" Binding="person_attribute9" Left="631px" Top="203px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Other ward unspecified" Binding="person_attribute11" Left="630px" Top="266px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="residence of this patient(village)" Binding="person_attribute12" Left="184px" Top="311px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="residence of this patient(Street)" Binding="person_attribute13" Left="635px" Top="312px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="telephone number of the patient" Binding="person_attribute14" Left="184px" Top="351px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="10 cell leader name" Binding="person_attribute15" Left="517px" Top="351px" Width="281px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Head household of the patient" Binding="person_attribute16" Left="14px" Top="411px" Width="319px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="telephone number of head household of the patient" Binding="person_attribute26" Left="649px" Top="413px" Width="154px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of treatment support of this patient" Binding="person_attribute27" Left="15px" Top="470px" Width="319px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="CBHS number" Binding="person_attribute56" Left="549px" Top="514px" Width="200px" Height="25px" TabIndex="189" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="DSS number" Binding="person_attribute29" Left="11px" Top="584px" Width="164px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="number of children" Binding="person_attribute32" Left="339px" Top="705px" Width="82px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Other health insurance specify" Binding="person_attribute59" Left="259px" Top="1063px" Width="522px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="support group" Binding="person_attribute23" Left="467px" Top="1261px" Width="322px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Other source of referral not specified" Binding="person_attribute25" Left="464px" Top="1455px" Width="311px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Name of 1st family member" Binding="person_attribute41" Left="255px" Top="1791px" Width="550px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="DatePicker" HelpText="Date of first positive HIV test" Binding="person_attribute19" Left="222px" Top="1134px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="VCT number" Binding="person_attribute20" Left="632px" Top="1133px" Width="160px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="RadioButton" Text="Yes" HelpText="Yes, given today" Binding="161870" ParentBinding="person_attribute37" Left="208px" Top="1601px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="1630px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Other reasons for not signing consent form" Binding="person_attribute60" Left="202px" Top="1669px" Width="573px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="TextBox" HelpText="Unique identification number of tb patient" Binding="person_attribute55" Left="132px" Top="514px" Width="200px" Height="25px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Informed consent signed" HelpText="informed consent patient signed" Binding="person_attribute37" Left="11px" Top="1602px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="1509px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Patient referred from(select all that apply)" HelpText="patient referral source" Binding="person_attribute24" Left="8px" Top="1312px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Type of health insurance scheme" HelpText="Type of health insurance scheme" Binding="person_attribute58" Left="15px" Top="935px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Highest education level" HelpText="highest education level of the patient" Binding="person_attribute17" Left="15px" Top="823px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Village" HelpText="residence of this patient(village)" Binding="person_attribute12" Left="14px" Top="311px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Label" Text="Telephone number" HelpText="telephone number of the patient" Binding="person_attribute14" Left="14px" Top="351px" TabIndex="0" fontWeight="bold" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, 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="1599px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/></Item><Item WidgetType="Button" Text="Cancel" HelpText="cancel" Binding="cancel" Left="791px" Top="2367px" Width="70px" Height="30px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif"/><Item WidgetType="Button" Text="Submit" HelpText="submit" Binding="submit" Left="703px" Top="2367px" Width="70px" Height="32px" TabIndex="0" fontSize="12px" fontFamily="Verdana, &quot;Lucida Grande&quot;, &quot;Trebuchet MS&quot;, Arial, sans-serif" Id="submit"/></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']/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_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']/input[@bind='person_attribute9']/label" value="Other distict(please specify)"/><text xpath="xforms/group[@id='1']/input[@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']/input[@bind='person_attribute11']/label" value="Other ward(please specify)"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute11']/hint" value="Other ward unspecified"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute12']/label" value="Village"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute12']/hint" value="residence of this patient(village)"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute13']/label" value="Street"/><text xpath="xforms/group[@id='1']/input[@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']/input[@bind='person_attribute15']/label" value="10CELL_LEADER"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute15']/hint" value="10 cell leader name"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute16']/label" value="HEADD_HOUSEHOLD"/><text xpath="xforms/group[@id='1']/input[@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']/input[@bind='person_attribute23']/label" value="SUPPORT_GROUP"/><text xpath="xforms/group[@id='1']/input[@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']/input[@bind='person_attribute25']/label" value="OTHER_PATREF"/><text xpath="xforms/group[@id='1']/input[@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']/input[@bind='person_attribute27']/label" value="TXT_SUPPORTER"/><text xpath="xforms/group[@id='1']/input[@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']/input[@bind='person_attribute29']/label" value="DSS_NO"/><text xpath="xforms/group[@id='1']/input[@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']/input[@bind='person_attribute18']/label" value="EDU_OTHER"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute18']/hint" value="Other education level"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute35']/label" value="OCCUP_OTHER"/><text xpath="xforms/group[@id='1']/input[@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 &lt;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']/input[@bind='person_attribute41']/label" value="FAMILY_NAME1"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute41']/hint" value="Name of 1st family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute42']/label" value="FAMILY_RELATION1"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute42']/hint" value="Relationship of 1st family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute43']/label" value="FAMILY_NACP1"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute43']/hint" value="NACPNO for 1st family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute44']/label" value="FAMILY_NAME2"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute44']/hint" value="Name of 2nd family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute45']/label" value="FAMILY_RELATION2"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute45']/hint" value="Relationship of 2ND family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute46']/label" value="FAMILY_NACP2"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute46']/hint" value="NACPNO for 2ND family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute47']/label" value="FAMILY_NAME3"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute47']/hint" value="Name of 3RD family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute48']/label" value="FAMILY_RELATION3"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute48']/hint" value="Relationship of 3RD family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute49']/label" value="FAMILY_NACP3"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute49']/hint" value="NACPNO for 3RD family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute50']/label" value="FAMILY_NAME4"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute50']/hint" value="Name of 4TH family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute51']/label" value="FAMILY_RELATION4"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute51']/hint" value="Relationship of 4TH family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute52']/label" value="FAMILY_NACP4"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute52']/hint" value="NACPNO for 4TH family member"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute53']/label" value="NICK_NAME"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute53']/hint" value="A well known name of a client"/><text 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']/input[@bind='person_attribute55']/label" value="TB_NO"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute55']/hint" value="Unique identification number of tb patient"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute56']/label" value="CBHS_NO"/><text xpath="xforms/group[@id='1']/input[@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 xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/hint" value="Type of health insurance scheme"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/item[@id='162044']/label" value="NHIF"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/item[@id='162045']/label" value="SHIB_NSSF"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/item[@id='162046']/label" value="CHF"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/item[@id='162047']/label" value="TIKA"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/item[@id='162048']/label" value="AAR"/><text xpath="xforms/group[@id='1']/select1[@bind='person_attribute58']/item[@id='162049']/label" value="OTHER_HEALTH_INSURANCE"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute59']/label" value="OTHER_HEALTH_INSURANCE_SPECIFY"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute59']/hint" value="Other health insurance specify"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute60']/label" value="CONSENT_OTHER"/><text xpath="xforms/group[@id='1']/input[@bind='person_attribute60']/hint" value="Other reasons for not signing consent form"/><text xpath="xforms/model/bind[@id='family_name'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='middle_name'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='given_name'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='identifier'][@message]" value="Data out of range"/><text xpath="xforms/model/bind[@id='person_attribute9'][@message]" value="The length of the field is more than the required, please check"/><text xpath="xforms/model/bind[@id='person_attribute11'][@message]" value="The length of the field is 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 xpath="xforms/model/bind[@id='person_attribute50'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute51'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='person_attribute52'][@message]" value="The length of the entered value is not correct, please enter correct value."/><text xpath="xforms/model/bind[@id='other_identifier_type_id'][@message]" value=""/><text xpath="xforms/model/bind[@id='other_identifier_location_id'][@message]" value=""/></xform><Form id="0"><text xpath="Form/Page[@Binding='Page1'][@Text]" value="Page1"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT34pxTOP60px' and @WidgetType='Label'][@Text]" value="Registration Form"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT34pxTOP60px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT34pxTOP60px' and @WidgetType='Label'][@Top]" value="30px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT34pxTOP60px' and @WidgetType='Label'][@Left]" value="48px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@HelpText]" value="Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@Top]" value="652px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@Left]" value="78px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox'][@Top]" value="100px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox'][@Left]" value="48px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox'][@Width]" value="820px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='Label'][@Text]" value="PATIENT INFORMATION"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='Label'][@HelpText]" value="Header Label"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='Label'][@Top]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='Label'][@Left]" value="0px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='Label'][@Width]" value="100%"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='Label'][@Text]" value="NACP 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="41px"/><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="100px"/><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="88px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='Label'][@Left]" value="9px"/><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='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="755px"/><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='5622' and @ParentBinding='person_attribute34' and @WidgetType='RadioButton'][@Text]" value="Other"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute34' 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_attribute34' and @WidgetType='RadioButton'][@Top]" value="782px"/><text 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="783px"/><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="782px"/><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="783px"/><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="753px"/><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="753px"/><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="752px"/><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="753px"/><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='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="852px"/><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='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="852px"/><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="816px"/><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="816px"/><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="755px"/><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="817px"/><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='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="738px"/><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='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="705px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute31' and @WidgetType='Label'][@Left]" value="10px"/><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="707px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Left]" value="134px"/><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="705px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute31' and @WidgetType='RadioButton'][@Left]" value="87px"/><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 &lt;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 &lt;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="707px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute39' and @WidgetType='Label'][@Left]" value="439px"/><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="704px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Left]" value="704px"/><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="704px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute39' and @WidgetType='RadioButton'][@Left]" value="749px"/><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="709px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='Label'][@Left]" value="205px"/><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="503px"/><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_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="391px"/><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_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="451px"/><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_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="394px"/><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_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="467px"/><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='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="450px"/><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='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="382px"/><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_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="315px"/><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="354px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='Label'][@Left]" value="360px"/><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="302px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT0pxTOP249px' and @WidgetType='Label'][@Left]" value="0px"/><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_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="247px"/><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='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="273px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='LEFT384pxTOP222px' and @WidgetType='Label'][@Left]" value="570px"/><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="270px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='5622' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="470px"/><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="243px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161009' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="470px"/><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="273px"/><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='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="243px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161008' 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="273px"/><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="244px"/><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="271px"/><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="244px"/><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="274px"/><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="246px"/><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='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="239px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161010' and @ParentBinding='person_attribute10' and @WidgetType='RadioButton'][@Left]" value="620px"/><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="235px"/><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_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="204px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute8' and @WidgetType='Label'][@Left]" value="11px"/><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="206px"/><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='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="204px"/><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="205px"/><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="203px"/><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="203px"/><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='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="190px"/><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='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="77px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='Label'][@Left]" value="569px"/><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="77px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='Label'][@Left]" value="255px"/><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="1747px"/><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_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="1752px"/><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='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="1748px"/><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="1748px"/><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_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="1791px"/><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='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="1833px"/><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="1871px"/><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="1910px"/><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="1952px"/><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="1989px"/><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="2032px"/><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="2073px"/><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="2114px"/><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="2154px"/><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="2189px"/><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='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="2233px"/><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='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="1737px"/><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="1704px"/><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='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 @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Top]" value="1632px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161939' and @ParentBinding='person_attribute37' and @WidgetType='RadioButton'][@Left]" value="150px"/><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="1584px"/><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='161052' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Text]" value="On ART"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161052' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@HelpText]" value="On ART"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161052' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Top]" value="1512px"/><text 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="1509px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1175' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Left]" value="236px"/><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="1548px"/><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='161050' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Text]" value="No records available"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161050' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@HelpText]" value="No records available"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161050' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Top]" value="1510px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161050' and @ParentBinding='person_attribute36' and @WidgetType='CheckBox'][@Left]" value="528px"/><text 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="1549px"/><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='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="1492px"/><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='161020' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="PLHIV group"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161020' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="PLHIV group"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161020' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1422px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161020' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="258px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161039' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="HBC"/><text 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="1362px"/><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 @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="RCH/PMTCT/EID"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161021' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Top]" value="1392px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='161021' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Left]" value="478px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160546' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@Text]" value="STI program/clinic"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='160546' and @ParentBinding='person_attribute24' and @WidgetType='CheckBox'][@HelpText]" value="Sexually transmitted 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="1362px"/><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="1337px"/><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="1337px"/><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='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="1452px"/><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="1297px"/><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='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="1208px"/><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='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="1134px"/><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_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="1173px"/><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_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="1139px"/><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='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="1171px"/><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='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="1170px"/><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="1169px"/><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="1169px"/><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='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="1113px"/><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='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="875px"/><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='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="685px"/><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_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="627px"/><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='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="657px"/><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='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="627px"/><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="627px"/><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="657px"/><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="627px"/><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="657px"/><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="627px"/><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='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="562px"/><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='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="586px"/><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='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="566px"/><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='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="934px"/><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="976px"/><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 @WidgetType='GroupBox']/Item[@Binding='162047' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Text]" value="Tiba Kwa Kadi (TIKA)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162047' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@HelpText]" value="TIKA"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162047' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Top]" value="935px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162047' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Left]" value="575px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162045' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Text]" value="NSSF Social Health Insurance Benefit (SHIB)"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162045' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@HelpText]" value="SHIB_NSSF"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162045' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Top]" value="974px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162045' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162049' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Text]" value="Other Health Insurance"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162049' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@HelpText]" value="OTHER_HEALTH_INSURANCE"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162049' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Top]" value="1015px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162049' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Left]" value="255px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162048' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Text]" value="AAR"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162048' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@HelpText]" value="AAR"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162048' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Top]" value="1015px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='162048' and @ParentBinding='person_attribute58' and @WidgetType='RadioButton'][@Left]" value="576px"/><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="1063px"/><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='true' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@Text]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='true' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@HelpText]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='true' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@Top]" value="893px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='true' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@Left]" value="266px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@Text]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@HelpText]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@Top]" value="894px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute57' and @WidgetType='RadioButton'][@Left]" value="348px"/><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="896px"/><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_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="1222px"/><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='1066' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@Text]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@HelpText]" value="NO"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@Top]" value="1224px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1066' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@Left]" value="453px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@Text]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@HelpText]" value="YES"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@Top]" value="1225px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='1065' and @ParentBinding='person_attribute22' and @WidgetType='RadioButton'][@Left]" value="535px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='true' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@Text]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='true' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@HelpText]" value="Yes"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='true' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@Top]" value="591px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='true' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@Left]" value="481px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@Text]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@HelpText]" value="No"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@Top]" value="592px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='false' and @ParentBinding='person_attribute54' and @WidgetType='RadioButton'][@Left]" value="567px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='F' and @ParentBinding='gender' and @WidgetType='RadioButton'][@Text]" value="Female"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='F' and @ParentBinding='gender' and @WidgetType='RadioButton'][@HelpText]" value="Female"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='F' and @ParentBinding='gender' and @WidgetType='RadioButton'][@Top]" value="592px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='F' and @ParentBinding='gender' and @WidgetType='RadioButton'][@Left]" value="732px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='M' and @ParentBinding='gender' and @WidgetType='RadioButton'][@Text]" value="Male"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='M' and @ParentBinding='gender' and @WidgetType='RadioButton'][@HelpText]" value="Male"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='M' and @ParentBinding='gender' and @WidgetType='RadioButton'][@Top]" value="593px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='M' and @ParentBinding='gender' and @WidgetType='RadioButton'][@Left]" value="665px"/><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="569px"/><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="567px"/><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_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="517px"/><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_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="517px"/><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_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="1671px"/><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="1706px"/><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="156px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='Label'][@Left]" value="19px"/><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="1265px"/><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_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="1833px"/><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_attribute43' and @WidgetType='TextBox'][@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='TextBox'][@Top]" value="1869px"/><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="1909px"/><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="1949px"/><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="1990px"/><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="2029px"/><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="2069px"/><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="2109px"/><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="2147px"/><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='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="2189px"/><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_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="2230px"/><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='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="1392px"/><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="1421px"/><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='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="36px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Left]" value="125px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='identifier' and @WidgetType='TextBox'][@Width]" value="412px"/><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="110px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='given_name' and @WidgetType='TextBox'][@Left]" value="10px"/><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='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="109px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='middle_name' and @WidgetType='TextBox'][@Left]" value="255px"/><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='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="106px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='family_name' and @WidgetType='TextBox'][@Left]" value="570px"/><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='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="152px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute53' and @WidgetType='TextBox'][@Left]" value="106px"/><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='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="203px"/><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='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="266px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute11' and @WidgetType='TextBox'][@Left]" value="630px"/><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='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="311px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='TextBox'][@Left]" value="184px"/><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='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="312px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute13' and @WidgetType='TextBox'][@Left]" value="635px"/><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='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="351px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='TextBox'][@Left]" value="184px"/><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="351px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute15' and @WidgetType='TextBox'][@Left]" value="517px"/><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_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="411px"/><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="413px"/><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_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="470px"/><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='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="514px"/><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="584px"/><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_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="705px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute32' and @WidgetType='TextBox'][@Left]" value="339px"/><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='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="1063px"/><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='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="1261px"/><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='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="1455px"/><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="1791px"/><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="1134px"/><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="1133px"/><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="1601px"/><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="1630px"/><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="1669px"/><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="514px"/><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='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="1602px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute37' and @WidgetType='Label'][@Left]" value="11px"/><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="1509px"/><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_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="1312px"/><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_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="935px"/><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_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="823px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute17' and @WidgetType='Label'][@Left]" value="15px"/><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="311px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute12' and @WidgetType='Label'][@Left]" value="14px"/><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="351px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='LEFT48pxTOP100px' and @WidgetType='GroupBox']/Item[@Binding='person_attribute14' and @WidgetType='Label'][@Left]" value="14px"/><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="1599px"/><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='cancel' and @WidgetType='Button'][@Text]" value="Cancel"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@HelpText]" value="cancel"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@Top]" value="2367px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@Left]" value="791px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='cancel' and @WidgetType='Button'][@Width]" value="70px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Text]" value="Submit"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@HelpText]" value="submit"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Top]" value="2367px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Left]" value="703px"/><text xpath="Form/Page[@Binding='Page1']/Item[@Binding='submit' and @WidgetType='Button'][@Width]" value="70px"/></Form></LanguageText></Language></PurcForm>
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