DREAM Forms

dic type	ctrl type	order	column name	value index	description	view condition
String	Linea di divisione	1		1	History
String	Select	2	vt1	0	Does the client smoke Cigarettes ?
Numeric	Text box	3	vn1	0	Number of years the client has smoked cigarretes
Numeric	Text box	4	vn2	0	Number of cigarretes the client smokes per day
String	Select	5	vt2	0	Other form of tobacco used by the client ?
String	Select	6	vt3	0	Does the client take alcohol?
String	Select	7	vt4	0	Client's HIV Status?
Boolan (Yes/No)	Select	8	vb1	0	Does the client have a family history of cancer?
String	Text box	9	vt5	0	Previous Cancer Treatment (other)
Boolan (Check Box)	Check box	10	vb21	0	Chemotherapy
Boolan (Check Box)	Check box	11	vb22	0	Radiotherapy
Boolan (Check Box)	Check box	12	vb23	0	Surgery
Boolan (Check Box)	Check box	13	vb24	0	Hormonal therapy
Datetime	Date Picker	14	vd3	0	LMP Date
String	Linea di divisione	15		1	Common Signs and Symptoms
Boolan (Check Box)	Check box	16	vb4	0	None
Boolan (Check Box)	Check box	17	vb5	0	Dyspepsia
Boolan (Check Box)	Check box	18	vb6	0	Blood in stool
Boolan (Check Box)	Check box	19	vb7	0	Yellow eyes
Boolan (Check Box)	Check box	20	vb8	0	Blood in urine
Boolan (Check Box)	Check box	21	vb9	0	Nose Bleeding
Boolan (Check Box)	Check box	22	vb10	0	Difficulty in swallowing
Boolan (Check Box)	Check box	23	vb11	0	Weight loss
Boolan (Check Box)	Check box	24	vb12	0	Easy fatigability
Boolan (Check Box)	Check box	25	vb13	0	Abnormal vaginal bleeding
Boolan (Check Box)	Check box	26	vb14	0	Changing/enlarging skin moles
Boolan (Check Box)	Check box	27	vb15	0	Chronic skin ulcers
Boolan (Check Box)	Check box	28	vb16	0	Lumps/swellings
Boolan (Check Box)	Check box	29	vb17	0	Chronic cough
Boolan (Check Box)	Check box	30	vb18	0	Persistent headaches
Boolan (Check Box)	Check box	31	vb19	0	Changing bowel habits
Boolan (Check Box)	Check box	32	vb20	0	Post-coital bleeding
String	Text box	33	vt6	0	Other (specify)
String	Linea di divisione	34		1	Screening
String	Select	35	vt15	1	Visit Type
String	Select	36	vt30	0	Screening Type
String	Text box	37	vt7	0	Cancer Type NOT USED
Boolan (Check Box)	Check box	38	vb30	0	Cancer Type: Cervical
Boolan (Check Box)	Check box	39	vb31	0	Cancer Type: Breast
Boolan (Check Box)	Check box	40	vb32	0	Cancer Type: Colorectal
Boolan (Check Box)	Check box	41	vb33	0	Cancer Type: Retinoblastoma
Boolan (Check Box)	Check box	42	vb34	0	Cancer Type: Prostate
Boolan (Check Box)	Check box	43	vb35	0	Cancer Type: Oral cancer
String	Text box	44	vt21	1	other 1 not used
String	Text box	45	vt22	1	other 2 not used
String	Linea di divisione	46		1	Colorectal	vb32
Boolan (Yes/No)	Select	47	vb2	0	Test result for faecal occult blood test	vb32
String	Select	48	vt8	0	Treatment (Occult blood)	vb32
String	Select	49	vt9	0	Colonoscopy	vb32
String	Select	50	vt10	0	Treatment for colonoscopy	vb32

id dictionary	FRM_CANCER_SCR
description	Cancer Screening
is single ?
category
order	70
v. index	15
used
hide in forms
filter hivpos	ALL
filter gender	F
filter agemin	15
filter agemax	150

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