DREAM Forms

dic type	ctrl type	order	column name	description	view condition
String	Linea di divisione	1		Visit Type
Boolan (Yes/No)	Select	2	vb10	Visit Scheduled ?
String	Select	3	vt2	Visit By:
String	Linea di divisione	4		Population
String	Select	5	vt1	Population Type
String	Linea di divisione	6		If you have selected "Key Population" choose from the following:
Boolan (Check Box)	Check box	7	vb1	People who inject drugs
Boolan (Check Box)	Check box	8	vb2	Transgender
Boolan (Check Box)	Check box	9	vb3	Female sex worker
Boolan (Check Box)	Check box	10	vb4	People in prison and other closed settings
Boolan (Check Box)	Check box	11	vb42	Men who have Sex with Men(MSM)
String	Linea di divisione	12		If you have selected "Priority Population" choose from the following:
Boolan (Check Box)	Check box	13	vb5	Fisher folk
Boolan (Check Box)	Check box	14	vb6	Truck driver
Boolan (Check Box)	Check box	15	vb7	Adolescent and young girls
Boolan (Check Box)	Check box	16	vb8	Prisoner
Boolan (Check Box)	Check box	17	vb9	Not applicable
String	Linea di divisione	18		Sexual and Reproductive History
String	Select	19	vt7	Has patient ever had menses?
Datetime	Date Picker	20	vd1	When was your LMP Date ?
Boolan (Check Box)	Check box	21	vb29	Menopause
Boolan (Yes/No)	Select	22	vb30	Patient Pregnant?
Boolan (Yes/No)	Select	23	vb31	Wants to get pregnant in three months?
Boolan (Yes/No)	Select	24	vb32	Patient Breastfeeding?
String	Text box	25	vt8	ANC Number	vb30
Datetime	Date Picker	26	vd2	EDD	vb30
Boolan (Yes/No)	Select	27	vb33	ANC/PNC Profile	vb30
Numeric	Text box	28	vn1	Parity (gestational age of 24 weeks or more)	vb30
Numeric	Text box	29	vn2	Parity + (miscarriages or terminations)	vb30
Numeric	Text box	30	vn3	Gravida	vb30
String	Linea di divisione	31		PHDP Services
String	Select	32	vt4	Has the Client disclosed HIV status to their sexually active partner?
Boolan (Yes/No)	Select	33	vb13	STI Partner Notification
String	Select	34	vt5	Has the client's partner received on-site HIV testing?
String	Linea di divisione	35		-
Boolan (Yes/No)	Select	36	vb14	PHDP Services offered ?
String	Select	37	vt6	Family Planning Status
String	Linea di divisione	38		If currently using Family Planning or wants F.P. .. specify:
Boolan (Check Box)	Check box	39	vb15	Emergency contraceptive pills
Boolan (Check Box)	Check box	40	vb16	Oral Contraceptives Pills
Boolan (Check Box)	Check box	41	vb17	Injectible
Boolan (Check Box)	Check box	42	vb18	Implant
Boolan (Check Box)	Check box	43	vb19	Intrauterine Device
Boolan (Check Box)	Check box	44	vb20	Lactational Amenorhea Method
Boolan (Check Box)	Check box	45	vb21	Diaphram/Cervical Cap
Boolan (Check Box)	Check box	46	vb22	Fertility Awareness
Boolan (Check Box)	Check box	47	vb23	Tubal Ligation
Boolan (Check Box)	Check box	48	vb24	Condoms
Boolan (Check Box)	Check box	49	vb25	Vasectomy(Partner)
String	Linea di divisione	50		Not using Family Planning? Specify

id dictionary	FRM_HIVGREEN_KE
description	HIV Green card visit
is single ?
category
linked event
order	90
v. index	17
used
hide in forms
filter hivpos	HIV_YES
filter gender	ALL
filter agemin	0
filter agemax	150

Form fields