{
    "uuid" : "d72a2b14-f532-4f70-bd17-93e9b5ef5ba7",
    "xml_data" : "<htmlform formUuid=\ " c75f120a-04ec-11e3-8780-2b40bef9a44b \
    formName=\ " Visit Note \ formEncounterType=\ "
    d7151f82-c1f3-4152-a605-2f9ea7414a79 \ formVersion=\ ">
    \n\n
    <style type=\ " text / css \>
        \n #who-when-where {\n margin-bottom: 6px;\n border-bottom: 1px solid
        #ccc;\n }\n\n #who-when-where p {\n display: inline-block;\n
        padding-right: 20px;\n }\n\n #where > input[type=text] {\n display:
        inline-block;\n }\n\n .field-error {\n color: #ff6666;\n font-size:
        1.1em;\n display: block;\n }\n\n
        <ifMode mode=\ " VIEW \ include=\ " false \>\n #data-collection
            {\n display: inline-block;\n width: 58%;\n vertical-align: top;\n
            }\n\n #encounter-diagnoses-target {\n display: inline-block;\n width:
            40%;\n vertical-align: top;\n }\n\n #encounter-diagnoses-app {\n
            margin-bottom: 20px;\n }\n        </ifMode>
        \n
    </style>
    \n\n
    <ifMode mode=\ " VIEW \ include=\ " false \>
        \n
        <h2>
            <uimessage code=\ " referenceapplication.visitNote.title \ />
        </h2>
        \n\n
        <div id=\ " who-when-where \>
            \n
            <p id=\ " who \>
                \n
                <label>
                    <uimessage code=\ " coreapps.patientDashBoard.provider \ />
                </label>
                \n
                <span>
                    <encounterProvider default=\ " currentUser \
                        required=\ " true \ />
                </span>
                \n
            </p>
            \n
            <p id=\ " when \>
                \n
                <label>
                    <uimessage code=\ " coreapps.patientDashBoard.location \ />
                </label>
                \n
                <span>
                    <encounterLocation default=\ "
                        SessionAttribute:emrContext.sessionLocationId \ />
                </span>
                \n
            </p>
            \n
            <p id=\ " where \>
                \n
                <label>
                    <uimessage code=\ " coreapps.patientDashBoard.date \ />
                </label>
                \n
                <span>
                    <encounterDate id=\ " encounterDate \ default=\ " now \ />
                </span>
                \n
            </p>
            \n
        </div>
        \n
    </ifMode>
    \n\n
    <div id=\ " data-collection \>
        \n\n
        <encounterDiagnoses required=\ " true \
            selectedDiagnosesTarget=\ " encounter-diagnoses-target \ />
        \n\n
        <p>
            \n
            <label>
                <uimessage code=\ " coreapps.consult.freeTextComments \ />
            </label>
            \n
            <obs conceptId=\ " CIEL:162169 \ style=\ " textarea \ rows=\ " />
            \n
        </p>
        \n\n
    </div>
    \n\n
    <div id=\ " encounter-diagnoses-target \>\n    </div>
    \n\n
    <ifMode mode=\ " VIEW \ include=\ " false \>
        \n
        <div id=\ " buttons \>
            \n
            <submit submitClass=\ " confirm right \ submitCode=\ "
                general.save \ />
            \n
            <button type=\ " button \ class=\ " cancel \>
                <uimessage code=\ " general.cancel \ />
            </button>
            \n
        </div>
        \n
    </ifMode>
    \n\n
</htmlform>"
}