DREAM Forms

dic type	ctrl type	order	column name	value index	description	bgcolor
Datetime	Date Picker	1	vd1	0	positive for syphilis, received treatment (date)
Datetime	Date Picker	2	vd2	0	Option B+ (date)
Datetime	Date Picker	3	vd3	0	ARV less than 4 weeks before delivery (date)
Datetime	Date Picker	4	vd2	1	Partner tested for HIV (date)
Boolan (Yes/No)	Select	5	vb1	0	Partner tested for HIV Positive
Datetime	Date Picker	6	vd4	0	Tested for malaria (date)
Boolan (Yes/No)	Select	7	vb2	0	Tested for Malaria Positive
Datetime	Date Picker	8	vd1	1	CPN1 Fansidar (date)
Datetime	Date Picker	9	vd3	1	CPN2 Fansidar (date)
Datetime	Date Picker	10	vd4	1	CPN3 Fansidar (date)
Datetime	Date Picker	11	vd1	2	CPN4 Fansidar (date)
Datetime	Date Picker	12	vd2	2	Mosquito net received (date)
Boolan (Check Box)	Check box	13	vb24	0	consents to home visits ?	0xFFFFF700
String	Linea di divisione	14		0	Obstetric background
Numeric	Text box	15	vn1	0	pregnancies
Numeric	Text box	16	vn2	0	Deliveries
Numeric	Text box	17	vn4	0	Stillbirths
Numeric	Text box	18	vn3	0	Abortions
Numeric	Text box	19	vn5	0	Born alive
Numeric	Text box	20	vn6	0	Currently alive
Numeric	Text box	21	vn7	0	Deceased
String	Linea di divisione	22		0	Vaccination
Datetime	Date Picker	23	vd3	2	Tetanus Vaccination (1st dose)
Datetime	Date Picker	24	vd4	2	Tetanus Vaccination (2nd dose)
Datetime	Date Picker	25	vd1	3	Tetanus Vaccination (3rd dose)
String	Linea di divisione	26		0	-
String	Select	27	vt1	0	Maternity facility where she was sent for delivery
String	Linea di divisione	28		0	Obstetric history
Boolan (Yes/No)	Select	29	vb9	0	Previous twin pregnancy ***
Boolan (Yes/No)	Select	30	vb10	0	Previous births with suction cup ***
Boolan (Yes/No)	Select	31	vb11	0	Bleeding complications in previous births? ***
Boolan (Yes/No)	Select	32	vb12	0	Manual removal of the placenta in previous births? ***
Boolan (Yes/No)	Select	33	vb13	0	Caesarean section in the last birth? ***
Boolan (Yes/No)	Select	34	vb14	0	First pregnancy aged 16 years? ***
Boolan (Yes/No)	Select	35	vb15	0	plus de 35 ans ? **
Boolan (Yes/No)	Select	36	vb16	0	Breech presentation in previous births ***
Boolan (Yes/No)	Select	37	vb17	0	Had 5 or more births ***
Boolan (Yes/No)	Select	38	vb18	0	Last pregnancy: stillbirth? ***
Boolan (Yes/No)	Select	39	vb19	0	Last pregnancy: did the newborn die during the 1st week? **
Boolan (Yes/No)	Select	40	vb20	0	Did you have 2 or more miscarriages or stillbirth? **
Boolan (Yes/No)	Select	41	vb21	0	Have you had a newborn weighing more than 4 kilos? **
Boolan (Yes/No)	Select	42	vb22	0	Have high B. P. or edema in previous pregnancies? **
Boolan (Yes/No)	Select	43	vb23	0	have seizures in previous pregnancies? **
Boolan (Yes/No)	Select	44	vb3	0	Did you have seizures in the absence of pregnancy? *
Boolan (Yes/No)	Select	45	vb4	0	Are you very hungry, thirsty and urinate a lot? *
Boolan (Yes/No)	Select	46	vb5	0	Tem dysúria and polaquiúria? *
Boolan (Yes/No)	Select	47	vb6	0	Have you had a cough and expectoration for more than two weeks? *
Boolan (Yes/No)	Select	48	vb7	0	Do you have tuberculosis and are you undergoing treatment? *
Boolan (Yes/No)	Select	49	vb8	0	Did you have PTV in previous pregnancies? *
String	Linea di divisione	50		0	* Cuidados de saúde primários

id dictionary	FRM_RCA_GROSSES
description	Pregnancy
is single ?
category	CAT_PREGNANCY
linked event
order	5
v. index	5
used
hide in forms
filter hivpos	ALL
filter gender	ALL
filter agemin	0
filter agemax	150

Form fields