DREAM Forms

dic type	ctrl type	order	column name	value index	regex	score	formula	description
String	Text box	1	vt1	0				DIP Distancia Inter Pupilar
String	Select	1	vt1	0				campo 1
Datetime	Date Picker	1	vd1	0				BCG - 1 dose
Boolan (Yes/No)	Select	1	vb1	0				Conjonctive
Boolan (Check Box)	Check box	1	vb1	0				Urethral discharge
String	Select	1	vt1					Period (Visit type)
Boolan (Check Box)	Check box	1	vb1					Delayed ?
String	Linea di divisione	1						Abnormal Pap test results:
Boolan (Yes/No)	Select	1	vb1	0				1. Within the past year, have you been hit, slapped, kicked or physically hurt by someone in any way?
String	Linea di divisione	1		0				Over the last 2 weeks, how often have you been bothered by any of the following problems?
String	Select	1	vt1	0				How often do you have a drink containing alcohol?
Numeric	Text box	1	vn1	0	^[1-4]$			Session number of EAC
Boolan (Yes/No)	Select	1	vb1	0		1		Refusal positive result
Datetime	Date Picker	1	vd1	0				OVC Enrollment Date
String	Linea di divisione	1		0				Screening (positive if only one of the following symptoms is positive)
String	Select	1	vt1	0				Indication for TPT
String	Linea di divisione	1		0		0		Epilepsy Screening (positive if only one of the following 5 answers is positive)
Datetime	Date Picker	1	vd1	2			FIRST	Enrollment date
Datetime	Date Picker	1	vd1	0				Date of last seizure
String	Linea di divisione	1		0				Tetanus Toxoid for pregnant women
Datetime	Date Picker	1	vd1	0				Date
String	Linea di divisione	1		0				Over the last 2 weeks, how often have you been bothered by any of the following problems?
String	Linea di divisione	1		1				History
String	Linea di divisione	1		0				Visit Type
String	Linea di divisione	1		0				Psychosocial/Knowledge Criteria (applies to patients and caregivers)
Datetime	Date Picker	2	vd2	0				Hep B - 1 dose
String	Text box	2	vt2	0				Campo 2
String	Text box	2	vt2	0				SGF Saude Geral Familiar
Datetime	Date Picker	2	vd1	0				1st Dose
Boolan (Yes/No)	Select	2	vb2	0				Œdème
Boolan (Check Box)	Check box	2	vb2	0				Genital Ulcer
Boolan (Yes/No)	Select	2	vb1			1		Cough
Boolan (Check Box)	Check box	2	vb1					Atypical squamous cells of undetermined significance (ASC-US)
Boolan (Yes/No)	Select	2	vb2	0				2. Are you in a relationship with a person who physically hit you?
String	Select	2	vt1	0				1 - Little interest or pleasure in doing things
Boolan (Check Box)	Check box	2	vb2	0				Performed in a single visit ?
String	Select	2	vt2	0				How often do you smoke?
Numeric	Text box	2	vn2	0	^[0-9]{1,2}$\|100$			Pill count adherence %
Boolan (Yes/No)	Select	2	vb2	0		1		Feeling too sick
String	Linea di divisione	2		0				Care giver
String	Select	2	vt1	0				Does the client smoke Cigarettes ?
Boolan (Yes/No)	Select	2	vb1	0		1		1. Have you ever lost consciousness, then fallen and at the same time foamed at the mouth (excessive salivation) and/or defecated or urinated on yourself?
Boolan (Yes/No)	Select	2	vb2	0			FIRST	Is client a transfer in?
String	Text box	2	vt2	0				Subcounty Registration Number
Numeric	Text box	2	vn1	0				Number of seizures since the last visit
String	Linea di divisione	2		0				Classes analyzed
String	Select	2	vt1	0				1. Feeling nervous, anxious or on edge
String	Linea di divisione	2						Documents
Boolan (Yes/No)	Select	2	vb10	0				Visit Scheduled ?
Boolan (Yes/No)	Select	2	vb1	0				1. Understands the nature of HIV infection and benefits of ART

Form fields