String
|
Linea di divisione
|
1
|
|
0
|
|
|
|
|
Informations
|
|
|
|
|
|
| | | |
String
|
Text box
|
2
|
vt10
|
0
|
|
|
|
|
Nom du prestataire
|
|
|
|
|
|
| | | |
Boolan (Yes/No)
|
Select
|
3
|
vb2
|
0
|
|
|
|
|
Tabagisme
|
|
|
|
|
|
| | | |
Boolan (Yes/No)
|
Select
|
4
|
vb1
|
0
|
|
|
|
|
Ménopausée
|
|
|
|
|
|
| | | |
Boolan (Yes/No)
|
Select
|
5
|
vb3
|
0
|
|
|
|
|
Alcool
|
|
|
|
|
|
| | | |
Numeric
|
Text box
|
6
|
vn1
|
0
|
|
|
|
|
Nombre de partenaire
|
|
|
|
|
|
| | | |
Numeric
|
Text box
|
7
|
vn2
|
0
|
|
|
|
|
Gestité
|
|
|
|
|
|
| | | |
Numeric
|
Text box
|
8
|
vn3
|
0
|
|
|
|
|
Parité
|
|
|
|
|
|
| | | |
String
|
Linea di divisione
|
9
|
|
0
|
|
|
|
|
Historique de dépistage CCU de la patiente
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
10
|
vb4
|
0
|
|
|
|
|
Dépistage de CCU dans le passé
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
11
|
vb5
|
0
|
|
|
|
|
IVA/IVL
|
vb4
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
12
|
vb6
|
0
|
|
|
|
|
Frottis
|
vb4
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
13
|
vb7
|
0
|
|
|
|
|
Test HPV
|
vb4
|
|
|
|
|
| | | |
Boolan (Yes/No)
|
Select
|
14
|
vb8
|
0
|
|
|
|
|
Résultat Positif ?
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
15
|
vb9
|
0
|
|
|
|
|
Cryo
|
vb8
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
16
|
vb10
|
0
|
|
|
|
|
Thermo
|
vb8
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
17
|
vb11
|
0
|
|
|
|
|
RAD
|
vb8
|
|
|
|
|
| | | |
Datetime
|
Date Picker
|
18
|
vd1
|
0
|
|
|
|
|
Date du dernier dépistage
|
|
|
|
|
|
| | | |
String
|
Linea di divisione
|
19
|
|
0
|
|
|
|
|
Type de visite
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
20
|
vb12
|
0
|
|
|
|
|
Test HPV initial
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
21
|
vb13
|
0
|
|
|
|
|
Test HPV de suivi (1 an)
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
22
|
vb14
|
0
|
|
|
|
|
Test de routine (3-5 ans)
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
23
|
vb15
|
0
|
|
|
|
|
IVA initial
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
24
|
vb16
|
0
|
|
|
|
|
IVA de routine
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
25
|
vb17
|
0
|
|
|
|
|
Cryothérapie / Thermo-coagulation
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
26
|
vb18
|
0
|
|
|
|
|
RAD (uniq. pour le sites de réf.)
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
27
|
vb19
|
0
|
|
|
|
|
Suivi post-traitement
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
28
|
vb20
|
0
|
|
|
|
|
Complication post-traitment en relation avec...
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
29
|
vb21
|
0
|
|
|
|
|
Thermocoagulation
|
vb20
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
30
|
vb22
|
0
|
|
|
|
|
Cryothérapie
|
vb20
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
31
|
vb23
|
0
|
|
|
|
|
RAD
|
vb20
|
|
|
|
|
| | | |
String
|
Linea di divisione
|
32
|
|
0
|
|
|
|
|
Dépistage
|
|
|
|
|
|
| | | |
Boolan (Yes/No)
|
Select
|
33
|
vb24
|
0
|
|
|
|
|
HPV fait ?
|
|
|
|
|
|
| | | |
Positive/Negative/Indet.
|
Select
|
34
|
vt1
|
0
|
|
|
|
|
HPV test result
|
vb24
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
35
|
vb25
|
0
|
|
|
|
|
Raison: suspicion de cancer
|
!vb24
|
|
|
|
|
| | | |
String
|
Text box
|
36
|
vt2
|
0
|
|
|
|
|
Autres raison à préciser:
|
!vb24
|
|
|
|
|
| | | |
Boolan (Yes/No)
|
Select
|
37
|
vb26
|
0
|
|
|
|
|
IVA Realisée ?
|
|
|
|
|
|
| | | |
Datetime
|
Date Picker
|
38
|
vd3
|
0
|
|
|
|
|
Date de réalisation
|
vb26
|
|
|
|
|
| | | |
Positive/Negative/Indet.
|
Select
|
39
|
vt3
|
0
|
|
|
|
|
IVA Résultat
|
vb26
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
40
|
vb27
|
0
|
|
|
|
|
Raison: suspicion de Cancer
|
!vb26
|
|
|
|
|
| | | |
String
|
Text box
|
41
|
vt4
|
0
|
|
|
|
|
Autres raison à préciser
|
!vb26
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
42
|
vb28
|
0
|
|
|
|
|
Dépistage Cancer sein
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
43
|
vb29
|
0
|
|
|
|
|
Masse/Nodule
|
vb28
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
44
|
vb30
|
0
|
|
|
|
|
Autre Lésion
|
vb28
|
|
|
|
|
| | | |
String
|
Linea di divisione
|
45
|
|
0
|
|
|
|
|
Traitement
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
46
|
vb31
|
0
|
|
|
|
|
Cryothérapie réalisée faite ce jour
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
47
|
vb32
|
0
|
|
|
|
|
Thermo-coagulation faite ce jour
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
48
|
vb33
|
0
|
|
|
|
|
Cryothérapie reportée
|
|
|
|
|
|
| | | |
Boolan (Check Box)
|
Check box
|
49
|
vb34
|
0
|
|
|
|
|
Thermocoagulation reportée
|
|
|
|
|
|
| | | |
String
|
Text box
|
50
|
vt5
|
0
|
|
|
|
|
Raison à préciser
|
|
|
|
|
|
| | | |