opensrp-anc/src/main/assets/json.form/anc_quick_check.json
{
"validate_on_submit": true,
"display_scroll_bars": true,
"count": "1",
"encounter_type": "Quick Check",
"entity_id": "",
"relational_id": "",
"form_version": "0.0.6",
"metadata": {
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"openmrs_entity": "concept",
"openmrs_data_type": "start",
"openmrs_entity_id": "163137AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"end": {
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"openmrs_entity": "concept",
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"openmrs_entity_id": "163138AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"today": {
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"openmrs_entity": "encounter",
"openmrs_entity_id": "encounter_date"
},
"deviceid": {
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
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"openmrs_entity_id": "163149AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"subscriberid": {
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"openmrs_entity": "concept",
"openmrs_data_type": "subscriberid",
"openmrs_entity_id": "163150AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"simserial": {
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"openmrs_entity": "concept",
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"openmrs_entity_id": "163151AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"phonenumber": {
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"openmrs_entity": "concept",
"openmrs_data_type": "phonenumber",
"openmrs_entity_id": "163152AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"encounter_location": "",
"look_up": {
"entity_id": "",
"value": ""
}
},
"step1": {
"title": "{{anc_quick_check.step1.title}}",
"fields": [
{
"key": "contact_reason",
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "160288AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"type": "native_radio",
"label": "{{anc_quick_check.step1.contact_reason.label}}",
"label_text_style": "bold",
"options": [
{
"key": "first_contact",
"text": "{{anc_quick_check.step1.contact_reason.options.first_contact.text}}",
"translation_text": "anc_quick_check.step1.contact_reason.options.first_contact.text",
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "165269AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "scheduled_contact",
"text": "{{anc_quick_check.step1.contact_reason.options.scheduled_contact.text}}",
"translation_text": "anc_quick_check.step1.contact_reason.options.scheduled_contact.text",
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "1246AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "specific_complaint",
"text": "{{anc_quick_check.step1.contact_reason.options.specific_complaint.text}}",
"translation_text": "anc_quick_check.step1.contact_reason.options.specific_complaint.text",
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "5219AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
}
],
"v_required": {
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"err": "{{anc_quick_check.step1.contact_reason.v_required.err}}"
}
},
{
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"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "5219AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"type": "check_box",
"label": "{{anc_quick_check.step1.specific_complaint.label}}",
"label_text_style": "bold",
"text_color": "#000000",
"options": [
{
"key": "abnormal_discharge",
"text": "{{anc_quick_check.step1.specific_complaint.options.abnormal_discharge.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "123395AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "changes_in_bp",
"text": "{{anc_quick_check.step1.specific_complaint.options.changes_in_bp.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": ""
},
{
"key": "changes_in_bp_down",
"text": "{{anc_quick_check.step1.specific_complaint.options.changes_in_bp_down.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": ""
},
{
"key": "constipation",
"text": "{{anc_quick_check.step1.specific_complaint.options.constipation.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "996AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "contractions",
"text": "{{anc_quick_check.step1.specific_complaint.options.contractions.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "163750AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "cough",
"text": "{{anc_quick_check.step1.specific_complaint.options.cough.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "143264AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "diarrhea",
"text": "{{anc_quick_check.step1.specific_complaint.options.diarrhea.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": ""
},
{
"key": "dizziness",
"text": "{{anc_quick_check.step1.specific_complaint.options.dizziness.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "156046AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "no_fetal_movement",
"text": "{{anc_quick_check.step1.specific_complaint.options.no_fetal_movement.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "1452AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "reduced_fetal_movement",
"text": "{{anc_quick_check.step1.specific_complaint.options.reduced_fetal_movement.text}}",
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"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "113377AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "fever",
"text": "{{anc_quick_check.step1.specific_complaint.options.fever.text}}",
"value": false,
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"openmrs_entity": "concept",
"openmrs_entity_id": "140238AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "flu_symptoms",
"text": "{{anc_quick_check.step1.specific_complaint.options.flu_symptoms.text}}",
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"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "137162AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "fluid_loss",
"text": "{{anc_quick_check.step1.specific_complaint.options.fluid_loss.text}}",
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"openmrs_entity": "concept",
"openmrs_entity_id": "148968AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "headache",
"text": "{{anc_quick_check.step1.specific_complaint.options.headache.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "139084AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "heartburn",
"text": "{{anc_quick_check.step1.specific_complaint.options.heartburn.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "139059AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "trauma",
"text": "{{anc_quick_check.step1.specific_complaint.options.trauma.text}}",
"value": false,
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"openmrs_entity": "concept",
"openmrs_entity_id": "124193AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "domestic_violence",
"text": "{{anc_quick_check.step1.specific_complaint.options.domestic_violence.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "141814AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "altered_skin_color",
"text": "{{anc_quick_check.step1.specific_complaint.options.altered_skin_color.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "136443AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "leg_cramps",
"text": "{{anc_quick_check.step1.specific_complaint.options.leg_cramps.text}}",
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"openmrs_entity": "concept",
"openmrs_entity_id": "135969AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "leg_redness",
"text": "{{anc_quick_check.step1.specific_complaint.options.leg_redness.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "165215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "anxiety",
"text": "{{anc_quick_check.step1.specific_complaint.options.anxiety.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "121543AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "depression",
"text": "{{anc_quick_check.step1.specific_complaint.options.depression.text}}",
"value": false,
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"openmrs_entity": "concept",
"openmrs_entity_id": "119537AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "other_psychological_symptoms",
"text": "{{anc_quick_check.step1.specific_complaint.options.other_psychological_symptoms.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "160198AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "nausea_vomiting_diarrhea",
"text": "{{anc_quick_check.step1.specific_complaint.options.nausea_vomiting_diarrhea.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "157892AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "oedema",
"text": "{{anc_quick_check.step1.specific_complaint.options.oedema.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "460AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "other_bleeding",
"text": "{{anc_quick_check.step1.specific_complaint.options.other_bleeding.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "147241AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "other_skin_disorder",
"text": "{{anc_quick_check.step1.specific_complaint.options.other_skin_disorder.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "119022AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "other_types_of_violence",
"text": "{{anc_quick_check.step1.specific_complaint.options.other_types_of_violence.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "158358AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "full_abdominal_pain",
"text": "{{anc_quick_check.step1.specific_complaint.options.full_abdominal_pain.text}}",
"value": false,
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"openmrs_entity": "concept",
"openmrs_entity_id": "139547AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "dysuria",
"text": "{{anc_quick_check.step1.specific_complaint.options.dysuria.text}}",
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"openmrs_entity": "concept",
"openmrs_entity_id": "118771AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "extreme_pelvic_pain",
"text": "{{anc_quick_check.step1.specific_complaint.options.extreme_pelvic_pain.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "165270AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "leg_pain",
"text": "{{anc_quick_check.step1.specific_complaint.options.leg_pain.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "114395AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "low_back_pain",
"text": "{{anc_quick_check.step1.specific_complaint.options.low_back_pain.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "116225AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "other_pain",
"text": "{{anc_quick_check.step1.specific_complaint.options.other_pain.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "114403AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "pelvic_pain",
"text": "{{anc_quick_check.step1.specific_complaint.options.pelvic_pain.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "131034AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "pruritus",
"text": "{{anc_quick_check.step1.specific_complaint.options.pruritus.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "879AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "shortness_of_breath",
"text": "{{anc_quick_check.step1.specific_complaint.options.shortness_of_breath.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "141600AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "tiredness",
"text": "{{anc_quick_check.step1.specific_complaint.options.tiredness.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "124628AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "bleeding",
"text": "{{anc_quick_check.step1.specific_complaint.options.bleeding.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "147232AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "visual_disturbance",
"text": "{{anc_quick_check.step1.specific_complaint.options.visual_disturbance.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "123074AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "vomiting",
"text": "{{anc_quick_check.step1.specific_complaint.options.vomiting.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": ""
},
{
"key": "other_specify",
"text": "{{anc_quick_check.step1.specific_complaint.options.other_specify.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
}
],
"v_required": {
"value": "true",
"err": "{{anc_quick_check.step1.specific_complaint.v_required.err}}"
},
"relevance": {
"step1:contact_reason": {
"type": "string",
"ex": "equalTo(.,\"specific_complaint\")"
}
}
},
{
"key": "specific_complaint_other",
"openmrs_entity_parent": "5219AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"openmrs_entity": "concept",
"openmrs_entity_id": "160632AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"type": "normal_edit_text",
"edit_text_style": "bordered",
"hint": "{{anc_quick_check.step1.specific_complaint_other.hint}}",
"v_regex": {
"value": "[A-Za-z\\s\\.\\-]*",
"err": "{{anc_quick_check.step1.specific_complaint_other.v_regex.err}}"
},
"relevance": {
"step1:specific_complaint": {
"ex-checkbox": [
{
"or": [
"other_specify"
]
}
]
}
}
},
{
"key": "danger_signs",
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"openmrs_entity": "concept",
"openmrs_entity_id": "160939AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"type": "check_box",
"label": "{{anc_quick_check.step1.danger_signs.label}}",
"label_text_style": "bold",
"text_color": "#000000",
"exclusive": [
"danger_none"
],
"options": [
{
"key": "danger_none",
"text": "{{anc_quick_check.step1.danger_signs.options.danger_none.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.danger_none.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "1107AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "danger_bleeding",
"text": "{{anc_quick_check.step1.danger_signs.options.danger_bleeding.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.danger_bleeding.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "150802AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "central_cyanosis",
"text": "{{anc_quick_check.step1.danger_signs.options.central_cyanosis.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.central_cyanosis.text}",
"label_info_text": "Bluish discolouration around the mucous membranes in the mouth, lips and tongue",
"label_info_title": "Central cyanosis",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "165216AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "convulsing",
"text": "{{anc_quick_check.step1.danger_signs.options.convulsing.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.convulsing.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "164483AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "danger_fever",
"text": "{{anc_quick_check.step1.danger_signs.options.danger_fever.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.danger_fever.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "140238AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "severe_headache",
"text": "{{anc_quick_check.step1.danger_signs.options.severe_headache.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.severe_headache.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "139081AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "visual_disturbance",
"text": "{{anc_quick_check.step1.danger_signs.options.visual_disturbance.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.visual_disturbance.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "123074AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "imminent_delivery",
"text": "{{anc_quick_check.step1.danger_signs.options.imminent_delivery.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.imminent_delivery.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "162818AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "labour",
"text": "{{anc_quick_check.step1.danger_signs.options.labour.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.labour.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "145AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "looks_very_ill",
"text": "{{anc_quick_check.step1.danger_signs.options.looks_very_ill.text}}",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "163293AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "severe_vomiting",
"text": "{{anc_quick_check.step1.danger_signs.options.severe_vomiting.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.severe_vomiting.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "118477AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "severe_pain",
"text": "{{anc_quick_check.step1.danger_signs.options.severe_pain.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.severe_pain.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "163477AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "severe_abdominal_pain",
"text": "{{anc_quick_check.step1.danger_signs.options.severe_abdominal_pain.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.severe_abdominal_pain.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "165271AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
{
"key": "unconscious",
"text": "{{anc_quick_check.step1.danger_signs.options.unconscious.text}}",
"translation_text": "anc_quick_check.step1.danger_signs.options.unconscious.text",
"value": false,
"openmrs_entity_parent": "",
"openmrs_entity": "concept",
"openmrs_entity_id": "123818AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
}
],
"v_required": {
"value": "true",
"err": "{{anc_quick_check.step1.danger_signs.v_required.err}}"
},
"relevance": {
"rules-engine": {
"ex-rules": {
"rules-file": "quick_check_relevance_rules.yml"
}
}
}
}
]
},
"properties_file_name": "anc_quick_check"
}