DREAM Forms

dic type	ctrl type	order	column name	description	view condition
Boolan (Yes/No)	Select	1	vb1	1. Within the past year, have you been hit, slapped, kicked or physically hurt by someone in any way?
String	Select	2	vt4	State the perpetrator	vb1
String	Text box	3	vt5	Specify who (if other was previously selected)	vb1
Boolan (Yes/No)	Select	4	vb2	2. Are you in a relationship with a person who physically hit you?
String	Select	5	vt6	State the perpetrator	vb2
String	Text box	6	vt7	Specify who (if other was previously selected)	vb2
Boolan (Yes/No)	Select	7	vb3	3. Are you in a relationship with a person who threatens, frightens or insults you or treats you badly?
String	Select	8	vt8	State the perpetrator	vb3
String	Text box	9	vt9	Specify who (if other was previously selected)	vb3
Boolan (Yes/No)	Select	10	vb4	4. Are you in relationship with a person who forces you to participate in sexual activities that make you feel uncomfortable?
String	Select	11	vt10	State the perpetrator	vb4
String	Text box	12	vt11	Specify who (if other was previously selected)	vb4
Boolan (Yes/No)	Select	13	vb5	5. Have you ever experienced any of the above with someone you do not have a relationship with?
String	Select	14	vt12	State the perpetrator	vb5
String	Text box	15	vt13	Specify who (if other was previously selected)	vb5
Boolan (Yes/No)	Select	16	vb6	Did the patient seek help after experiencing GBV?
String	Select	17	vt1	from who ?
Datetime	Date Picker	18	vd1	Date when the patient sought help
String	Select	19	vt2	Outcome after seeking help
String	Text box	20	vt3	Reason for not seeking help

id dictionary	FRM_GBV_SCR
description	Violence against Men and Women
is single ?
category
linked event
order	10
v. index	7
used
hide in forms
filter hivpos	ALL
filter gender	ALL
filter agemin	0
filter agemax	150

Form fields