DREAM Forms

dic type	ctrl type	order	column name	value index	regex	score	formula	description	bgcolor
String	Text box	1	vt1	0				DIP Distancia Inter Pupilar
String	Text box	1	vt1	0				campo 1
Datetime	Date Picker	1	vd1	0				BCG - 1 dose
Boolan (Yes/No)	Select	1	vb1	0				Conjonctive
Datetime	Date Picker	1	vd1	0				positive for syphilis, received treatment (date)
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
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)
String	Linea di divisione	1		0				GENERAL INFORMATION AND MEDICAL HISTORY
String	Linea di divisione	1		0				Antiseizure medication in use	0xFFB2F5B6
String	Text box	1	vt10	0				Nom du prestataire
String	Select	1	vt1	0				Service being offered at first enrolment
String	Text box	1	vt6	1				Patient ANC Number
String	Linea di divisione	1		0				Interviewer read: "The next questions ask about difficulties you may have doing certain activities.”
Boolan (Yes/No)	Select	1	vb1	0				Were there any seizures between the last visit and today?
String	Linea di divisione	1		1				Postpartum Visit
String	Linea di divisione	1		0				Brain complications - Stroke
Datetime	Date Picker	1	vd1	0				Date of Admission
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
Datetime	Date Picker	2	vd2	0				Option B+ (date)
Boolan (Check Box)	Check box	2	vb2	0				Genital Ulcer
Boolan (Check Box)	Check box	2	vb1			1		Cough
Boolan (Check Box)	Check box	2	vb1					Atypical squamous cells of undetermined significance (ASC-US)
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

Form fields