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Want to help improve this module? Contact Darius JazayeriContact Mark Goodrich.

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Code Block
<htmlform>
<macros>
    lightgrey=#e0e0e0
    lightblue=#e0e0ff
</macros>
...
<table border="0" width="100%">
    <tr valign="top">
      <td width="50%">
        <table width="100%" border="1" cellspacing="0" cellpadding="2">
            <tr>
              <td bgcolor="$lightgrey"><b>3. Anamnese</b></td>
            </tr>
            <tr>
              <td>
		 Symptomes: <br/>
                 <obs conceptId="432" style="checkbox" labelText="Visite de routine, pas de probleme"/> <br/>
                 <obs conceptId="1364" rows="10" cols="60"/>
                 <br/><br/>

                Conditions socioeconomiques:
                <table><tr><td>
                  <obs conceptId="2861" answerConceptId="1309" answerLabel="necessite d'un emploi"/> <br/>
                  <obs conceptId="2861" answerConceptId="2862" answerLabel="faim"/> <br/>
                  <obs conceptId="2861" answerConceptId="2863" answerLabel="frais scolaire"/> <br/>
                  <obs conceptId="2861" answerConceptId="5622" answerLabel="autre"/>
                </td><td>
                  <obs conceptId="2861" answerConceptId="2864" answerLabel="probleme avec maison"/> <br/>
                  <obs conceptId="2861" answerConceptId="2865" answerLabel="enterrement"/> <br/>
                  <obs conceptId="2861" answerConceptId="2866" answerLabel="inaccessibilite de l'eau"/>
                </td></tr></table>

		<br/>
                <b>Examen Clinique:</b> <br/>
		<table width="100%"><tr valign="top">
		<td width="50%">
			<obs conceptId="5088" labelText="Temp:"/> C <br/>
			<obs conceptId="5087" labelText="Pouls:"/>/min <br/>
			<obs conceptId="5089" labelText="Poids:"/>kg <br/>
			<obs conceptId="2137" labelText="IMC:"/>kg/m2 <br/>
		</td><td width="50%">
			<obs conceptId="5242" labelText="FR:"/>/min <br/>
			<obs conceptId="5085" labelText="TA:"/>
			<obs conceptId="5086" labelText="/"/> <br/>
			<obs conceptId="5090" labelText="Taille:"/>cm
		</td>
		</tr></table>
              </td>
            </tr>
        </table>
      </td>
      <td width="50%">
        <table width="100%" border="1" cellspacing="0" cellpadding="2">
            <tr>
              <td bgcolor="$lightgrey"><b>4. Anamnese systematique et depistage TBC:</b></td>
            </tr>
            <tr>
		<td>
			<table width="100%">
				<obsgroup groupingConceptId="2162">
				<tr>
					<td>
						<b>Toux:</b>
						<obs conceptId="1734" answerConceptId="107" answerLabel="non"/>
						<obs conceptId="1293" answerConceptId="107" answerLabel="oui"/>
					</td>
					<td colspan="2">
						duree:
						<obs conceptId="2160" labelText=""/>semaines
						<obs conceptId="2161" labelText=""/>mois
					</td>
				</tr>
				<tr>
					<td></td>
					<td><obs conceptId="1293" answerConceptId="2128" answerLabel="seche"/></td>
					<td><obs conceptId="1293" answerConceptId="970" answerLabel="hemoptysie"/></td>
				</tr>
				<tr>
					<td></td>
					<td><obs conceptId="1293" answerConceptId="5957" answerLabel="productive"/></td>
					<td><obs conceptId="1293" answerConceptId="5960" answerLabel="dyspnee"/></td>
				</tr>
				<tr>
					<td></td>
					<td colspan="2"><obs conceptId="1293" answerConceptId="136" answerLabel="douleur thoracique"/></td>
				</tr>
				</obsgroup>
				<tr>
					<td align="right"><b>Sueurs nocturnes</b></td>
					<td colspan="2">
						<obs conceptId="1734" answerConceptId="6029" answerLabel="non"/>
						<obs conceptId="1293" answerConceptId="2164" answerLabel="moins de 3 semaines"/>
						<obs conceptId="1293" answerConceptId="2163" answerLabel="plus de 3 semaines"/>
					</td>
				</tr>
				<tr valign="top">
					<td align="right"><b>Fievre</b></td>
					<td colspan="2">
						<obs conceptId="1734" answerConceptId="5945" answerLabel="non"/>
						<obsgroup groupingConceptId="1292">
							<obs conceptId="1293" answerConceptId="5945" answerLabel="oui,"/>
							<br/>
							duree:
							<obs conceptId="1294" labelText=""/>jours
							<obs conceptId="2160" labelText=""/>semaines
							<obs conceptId="2161" labelText=""/>mois
						</obsgroup>
					</td>
				</tr>
				<tr>
					<td align="right"><b>Perte de poids</b></td>
					<td colspan="2">
						<obs conceptId="1734" answerConceptId="832" answerLabel="non"/>
						<obs conceptId="1293" answerConceptId="832" answerLabel="oui moins de 10%"/>
						<obs conceptId="1293" answerConceptId="1352" answerLabel="oui plus de 10%"/>
					</td>
				</tr>
				<tr>
					<td align="right"><b>Contact TBC+:</b></td>
					<td colspan="2"><obs conceptId="2133" style="no_yes" labelText=""/></td>
				</tr>
			</table>
		</td>
            </tr>
            <tr>
              <td>
		<b>Resultat du depistage TBC</b> <obs conceptId="2136" labelText="" answerConceptIds="664,703" answerLabels="negatif,positif"/>
		<br/><br/>
	      </td>
            </tr>
            <tr>
              <td bgcolor="$lightgrey"><b>5. La sante sexuelle</b></td>
            </tr>
            <tr>
              <td>
                <table border="0">
                    <tr>
                      <td align="right">Sexuellement actif:</td>
                      <td><obs conceptId="2730" style="no_yes"/></td>
                    </tr>
                    <tr>
                      <td align="right">Dernieres regles</td>
                      <td><obs conceptId="968"/></td>
                    </tr>
                    <tr>
                      <td align="right">Planification familiale</td>
                      <td><obs conceptId="5271" style="no_yes"/></td>
                    </tr>
                    <tr>
                      <td align="right">Methode</td>
                      <td>
			<obs conceptId="374" answerConceptId="1720" answerLabel="abstinence"/>
			<obs conceptId="374" answerConceptId="780" answerLabel="contraceptifs oraux"/> <br/>
			<obs conceptId="374" answerConceptId="190" answerLabel="condoms"/>
			<obs conceptId="374" answerConceptId="5279" answerLabel="Depo-provera"/> <br/>
			<obs conceptId="374" answerConceptId="5622" answerLabel="autres"/>
			<obs conceptId="2877" labelText="(a specifier):"/>
		      </td>
                    </tr>
                    <tr>
                      <td align="right">Enceinte</td>
                      <td>
			<obs conceptId="5272" answerConceptIds="1066,1065" answerLabels="non,oui"/>
			<obs conceptId="5596" labelText="DPA"/>
		      </td>
                    </tr>
                    <tr>
                      <td align="right">Symptomes d'IST</td>
                      <td><obs conceptId="2731" size="40"/></td>
                    </tr>
                </table>
              </td>
            </tr>
        </table>
      </td>
    </tr>
</table>
...
</htmlform>

Global Properties

  • htmlformentry.dateFormat: lets you specify a date format (as defined in Java's SimpleDateFormat) that will be used to display all dates in HTML Forms. This will hold for entering new forms, and viewing/editing existing ones. (For example set the global property to "dd-MMM-yyyy" for an unambiguous date format like 31-Jan-2012.)

Required Privileges

The following privileges may be necessary for various activities. It may be necessary to create them manually, and add them to your user's role.

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