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Hypertension Screening.xml
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Hypertension Screening.xml
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<?xml version="1.0" encoding="UTF-8"?>
<html xmlns="http://www.w3.org/1999/xhtml" xmlns:xf="http://www.w3.org/2002/xforms" xmlns:ev="http://www.w3.org/2001/xml-events" xmlns:jr="http://openrosa.org/javarosa">
<head>
<title>Hypertension Screening</title>
<xf:model>
<xf:itext>
<translation lang="English">
<text id="hello">
<value>hello</value>
</text>
</translation>
</xf:itext>
<xf:instance>
<data id="hypertension">
<StartTime/>
<EndTime/>
<DeviceId/>
<SubscriberId/>
<FirstName/>
<MiddleName/>
<FamilyName/>
<AgeType/>
<BirthDateEstimated/>
<BirthDate/>
<AgeInYears/>
<AgeInMonths/>
<ApproximateAge/>
<NotEligible/>
<Gender/>
<AmpathId/>
<AmpathIdManual/>
<HctId/>
<HctIdManual/>
<NationalId/>
<PhoneNumber/>
<HistoryHtn/>
<HistoryDiabetes/>
<HistoryHeartDisease/>
<HistoryKidneyDisease/>
<HistoryHiv/>
<HistoryPregnancy/>
<HistoryOther/>
<MedicationsDiabetes/>
<MedicationsHypertension/>
<MedicationsHeartDisease/>
<BloodPressureSystolic/>
<BloodPressureDiastolic/>
<RandomBloodSugar/>
<HighBloodPressureUrgent/>
<HighSystolicNoMeds/>
<HighDiastolicNoMeds/>
<HighSystolicYesMeds/>
<HighDiastolicYesMeds/>
<HighBloodSugar/>
<ReferralMessageUrgent/>
<ReferralMessageDiabetes/>
<ReferralMessageHypertension/>
<ReferralMessagePoorlyControlled/>
<HealthCenterAppointment/>
<HealthCenterAppointmentDate/>
<EncounterProvider/>
<EncounterDate/>
</data>
</xf:instance>
<!-- basic tracking information -->
<xf:bind nodeset="/data/StartTime" type="dateTime" jr:preload="timestamp" jr:preloadParams="start"/>
<xf:bind nodeset="/data/EndTime" type="dateTime" jr:preload="timestamp" jr:preloadParams="end"/>
<xf:bind nodeset="/data/DeviceId" type="string" jr:preload="property" jr:preloadParams="deviceid"/>
<xf:bind nodeset="/data/SubscriberId" type="string" jr:preload="property" jr:preloadParams="subscriberid"/>
<!-- age to determine eligibility (>= 216 months old) -->
<xf:bind nodeset="/data/AgeType" type="string"/>
<xf:bind nodeset="/data/BirthDateEstimated" type="string"/>
<xf:bind nodeset="/data/BirthDate" relevant="/data/AgeType='BirthDate'" constraint=". <= today()" jr:constraintMsg="Birth dates must be before today." type="date"/>
<xf:bind nodeset="/data/AgeInYears" constraint=". >= 0 and . <= 110" type="int" relevant="/data/AgeType='AgeInYearsMonths'" jr:constraintMsg="Age must be between 0 and 110."/>
<xf:bind nodeset="/data/AgeInMonths" constraint=". >= 0 and . <= 11" type="int" relevant="/data/AgeType='AgeInYearsMonths' and /data/AgeInYears < 5" jr:constraintMsg="Age must be between 0 and 11."/>
<xf:bind nodeset="/data/ApproximateAge" readonly="true()" type="int" calculate="if(/data/AgeType='BirthDate', ((now()-/data/BirthDate) div 30.4375), (if(/data/AgeInMonths > 0, ((/data/AgeInYears * 12)+/data/AgeInMonths), (/data/AgeInYears * 12))))"/>
<xf:bind nodeset="/data/NotEligible" type="string" readonly="true()" relevant="/data/ApproximateAge = '' or /data/ApproximateAge < 216"/>
<!-- demographics -->
<xf:bind nodeset="/data/FirstName" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/MiddleName" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/FamilyName" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/Gender" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<!-- identifiers -->
<xf:bind nodeset="/data/AmpathId" type="barcode" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/AmpathIdManual" type="string" relevant="selected(/data/AmpathId, '') and /data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/HctId" type="barcode" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/HctIdManual" type="string" relevant="selected(/data/HctId, '') and /data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/NationalId" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/PhoneNumber" type="string" relevant="/data/ApproximateAge >= 216"/>
<!-- history -->
<xf:bind nodeset="/data/HistoryHtn" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/HistoryDiabetes" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/HistoryHeartDisease" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/HistoryKidneyDisease" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/HistoryHiv" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/HistoryPregnancy" required="true()" type="string" relevant="/data/ApproximateAge >= 216 and /data/Gender = 'Female'"/>
<xf:bind nodeset="/data/HistoryOther" type="string" relevant="/data/ApproximateAge >= 216"/>
<!-- medications -->
<xf:bind nodeset="/data/MedicationsDiabetes" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/MedicationsHypertension" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/MedicationsHeartDisease" required="true()" type="string" relevant="/data/ApproximateAge >= 216"/>
<!-- clinical measurements -->
<xf:bind nodeset="/data/BloodPressureSystolic" required="true()" type="int" relevant="/data/ApproximateAge >= 216" constraint=". > 0 and . < 300" jr:constraintMsg="Systolic blood pressure must be between 0 and 300"/>
<xf:bind nodeset="/data/BloodPressureDiastolic" required="true()" type="int" relevant="/data/ApproximateAge >= 216" constraint=". > 0 and . < 200" jr:constraintMsg="Diastolic blood pressure must be between 0 and 200"/>
<xf:bind nodeset="/data/RandomBloodSugar" required="true()" type="decimal" relevant="/data/ApproximateAge >= 216" constraint=". > 0 and . < 60 " jr:constraintMsg="Random blood sugar must be between 0 and 60"/>
<!-- flags for alerts -->
<xf:bind nodeset="/data/HighBloodPressureUrgent" type="string" relevant="/data/ApproximateAge >= 216" calculate="if(/data/BloodPressureSystolic >= 180 or /data/BloodPressureDiastolic >= 110, 'Yes', 'No') "/>
<xf:bind nodeset="/data/HighSystolicNoMeds" type="string" relevant="/data/ApproximateAge >= 216" calculate="if(/data/BloodPressureSystolic >= 160 and /data/BloodPressureSystolic < 180, 'Yes', 'No') "/>
<xf:bind nodeset="/data/HighDiastolicNoMeds" type="string" relevant="/data/ApproximateAge >= 216" calculate="if(/data/BloodPressureDiastolic >= 100 and /data/BloodPressureDiastolic < 110, 'Yes', 'No') "/>
<xf:bind nodeset="/data/HighSystolicYesMeds" type="string" relevant="/data/ApproximateAge >= 216" calculate="if(/data/BloodPressureSystolic >= 140 and /data/BloodPressureSystolic < 180 and /data/MedicationsHypertension = 'Yes', 'Yes', 'No') "/>
<xf:bind nodeset="/data/HighDiastolicYesMeds" type="string" relevant="/data/ApproximateAge >= 216" calculate="if(/data/BloodPressureDiastolic > 90 and /data/BloodPressureDiastolic < 110 and /data/MedicationsHypertension = 'Yes', 'Yes', 'No') "/>
<xf:bind nodeset="/data/HighBloodSugar" type="string" relevant="/data/ApproximateAge >= 216" calculate="if(/data/RandomBloodSugar > 7.0, 'Yes', 'No') "/>
<!-- referral messages -->
<xf:bind nodeset="/data/ReferralMessageUrgent" type="string" relevant="/data/ApproximateAge >= 216 and /data/HighBloodPressureUrgent = 'Yes'" readonly="true()"/>
<xf:bind nodeset="/data/ReferralMessageHypertension" type="string" relevant="/data/ApproximateAge >= 216 and /data/HighBloodPressureUrgent = 'No' and (/data/HighSystolicNoMeds = 'Yes' or /data/HighDiastolicNoMeds = 'Yes')" readonly="true()"/>
<xf:bind nodeset="/data/ReferralMessagePoorlyControlled" type="string" relevant="/data/ApproximateAge >= 216 and /data/HighBloodPressureUrgent = 'No' and (/data/HighSystolicYesMeds = 'Yes' or /data/HighDiastolicYesMeds = 'Yes')" readonly="true()"/>
<xf:bind nodeset="/data/ReferralMessageDiabetes" type="string" relevant="/data/ApproximateAge >= 216 and /data/HighBloodPressureUrgent = 'No' and /data/HighBloodSugar = 'Yes'" readonly="true()"/>
<!-- referral appointment -->
<xf:bind nodeset="/data/HealthCenterAppointment" type="string" relevant="/data/ApproximateAge >= 216 "/>
<xf:bind nodeset="/data/HealthCenterAppointmentDate" type="date" relevant="/data/ApproximateAge >= 216 and selected(/data/HealthCenterAppointment, 'Yes')" constraint=". >= today()" jr:constraintMsg="Sorry, only dates in the future are allowed"/>
<!-- encounter -->
<xf:bind nodeset="/data/EncounterProvider" type="string" relevant="/data/ApproximateAge >= 216"/>
<xf:bind nodeset="/data/EncounterDate" type="date" relevant="/data/ApproximateAge >= 216"/>
</xf:model>
</head>
<body>
<xf:group>
<xf:label>Patient Demographics</xf:label>
<xf:select1 ref="AgeType">
<xf:label>Age entry mode</xf:label>
<xf:item>
<xf:label>Enter full birthdate</xf:label>
<xf:value>BirthDate</xf:value>
</xf:item>
<xf:item>
<xf:label>Enter age in years</xf:label>
<xf:value>AgeInYearsMonths</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="BirthDateEstimated">
<xf:label>Age/Birthdate estimated</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
</xf:select1>
<xf:input ref="BirthDate">
<xf:label>Birth date</xf:label>
</xf:input>
<xf:input ref="AgeInYears">
<xf:label>Number of years</xf:label>
</xf:input>
<xf:input ref="AgeInMonths">
<xf:label>Number of months</xf:label>
</xf:input>
<xf:input ref="NotEligible">
<xf:label>Patient is under 18 and is not eligible for the study.
</xf:label>
</xf:input>
<xf:input ref="FirstName">
<xf:label>First name</xf:label>
</xf:input>
<xf:input ref="MiddleName">
<xf:label>Middle name</xf:label>
</xf:input>
<xf:input ref="FamilyName">
<xf:label>Family name</xf:label>
</xf:input>
<xf:select1 ref="Gender">
<xf:label>Gender</xf:label>
<xf:item>
<xf:label>Male</xf:label>
<xf:value>Male</xf:value>
</xf:item>
<xf:item>
<xf:label>Female</xf:label>
<xf:value>Female</xf:value>
</xf:item>
</xf:select1>
<xf:input ref="AmpathId">
<xf:label>AMPATH ID</xf:label>
<xf:hint>If no barcode, go to the next question.</xf:hint>
</xf:input>
<xf:input ref="AmpathIdManual">
<xf:label>AMPATH ID</xf:label>
</xf:input>
<xf:input ref="HctId">
<xf:label>HCT ID</xf:label>
<xf:hint>If no barcode, go to the next question.</xf:hint>
</xf:input>
<xf:input ref="HctIdManual">
<xf:label>HCT ID</xf:label>
</xf:input>
<xf:input ref="NationalId">
<xf:label>National ID</xf:label>
</xf:input>
<xf:input ref="PhoneNumber">
<xf:label>Contact phone number</xf:label>
</xf:input>
</xf:group>
<xf:group>
<xf:label>Patient History</xf:label>
<xf:select1 ref="HistoryHtn">
<xf:label>History of HTN</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
<xf:item>
<xf:label>Unknown</xf:label>
<xf:value>Unknown</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="HistoryDiabetes">
<xf:label>History of diabetes</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
<xf:item>
<xf:label>Unknown</xf:label>
<xf:value>Unknown</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="HistoryHeartDisease">
<xf:label>History of heart disease</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
<xf:item>
<xf:label>Unknown</xf:label>
<xf:value>Unknown</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="HistoryKidneyDisease">
<xf:label>History of kidney disease</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
<xf:item>
<xf:label>Unknown</xf:label>
<xf:value>Unknown</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="HistoryHiv">
<xf:label>History of HIV</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
<xf:item>
<xf:label>Unknown</xf:label>
<xf:value>Unknown</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="HistoryPregnancy">
<xf:label>History of pregnancy</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
<xf:item>
<xf:label>Unknown</xf:label>
<xf:value>Unknown</xf:value>
</xf:item>
</xf:select1>
<xf:input ref="HistoryOther">
<xf:label>Any other known diseases</xf:label>
</xf:input>
</xf:group>
<xf:group>
<xf:label>Patient Drugs</xf:label>
<xf:select1 ref="MedicationsDiabetes">
<xf:label>Drugs for diabetes</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="MedicationsHypertension">
<xf:label>Drugs for hypertension</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
</xf:select1>
<xf:select1 ref="MedicationsHeartDisease">
<xf:label>Drugs for heart disease</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
</xf:select1>
</xf:group>
<xf:group>
<xf:label>Clinical Elements</xf:label>
<xf:input ref="BloodPressureSystolic">
<xf:label>Systolic BP (mmHg)</xf:label>
<xf:hint>Measure the right arm while seated</xf:hint>
</xf:input>
<xf:input ref="BloodPressureDiastolic">
<xf:label>Diastolic BP (mmHg)</xf:label>
<xf:hint>Measure the right arm while seated</xf:hint>
</xf:input>
<xf:input ref="RandomBloodSugar">
<xf:label>Blood sugar (mmol/L)</xf:label>
</xf:input>
</xf:group>
<xf:group>
<xf:label>Referral Information</xf:label>
<xf:input ref="ReferralMessageUrgent">
<xf:label>Blood pressure extremely high. Patient needs immediate medical attention.</xf:label>
</xf:input>
<xf:input ref="ReferralMessageHypertension">
<xf:label>Patient is at risk for hypertension. Please refer to the Health Center.</xf:label>
</xf:input>
<xf:input ref="ReferralMessagePoorlyControlled">
<xf:label>Patient is poorly controlled. Please refer to the Health Center.</xf:label>
</xf:input>
<xf:input ref="ReferralMessageDiabetes">
<xf:label>Patient is at risk for diabetes. Please refer to the Health Center.</xf:label>
</xf:input>
<xf:select1 ref="HealthCenterAppointment">
<xf:label>Health center appointment</xf:label>
<xf:item>
<xf:label>Yes</xf:label>
<xf:value>Yes</xf:value>
</xf:item>
<xf:item>
<xf:label>No</xf:label>
<xf:value>No</xf:value>
</xf:item>
</xf:select1>
<xf:input ref="HealthCenterAppointmentDate">
<xf:label>Appointment Date</xf:label>
</xf:input>
</xf:group>
<xf:group>
<xf:label>Encounter Information</xf:label>
<xf:select1 ref="EncounterProvider">
<xf:label>Provider name</xf:label>
<xf:item>
<xf:label>Bob</xf:label>
<xf:value>Sally</xf:value>
</xf:item>
<xf:item>
<xf:label>Sally</xf:label>
<xf:value>Sally</xf:value>
</xf:item>
</xf:select1>
<xf:input ref="EncounterDate">
<xf:label>Encounter date</xf:label>
</xf:input>
</xf:group>
</body>
</html>