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69 lines
3.7 KiB
69 lines
3.7 KiB
<?xml version="1.0" encoding="ISO-8859-1"?> |
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<!-- Generated by Hand --> |
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<form> |
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<table type="form">form_urinary_soap</table> |
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<RealName>Urinary Symptoms</RealName> |
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<safename>urinary_soap</safename> |
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<style cells_per_row="2">layout</style> |
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<acl table="patients">med</acl> |
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<manual> |
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<section name="subjective" label="Subjective"> |
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<field name="urinary_complaints" label="Urinary Complaints" type="checkbox_combo_list" list="Urinary_Complaints" size="140" maxlength="255" labelcols="1" cols="1"/> |
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<field name="previous_cultures" label="Previous Cultures" type="textfield" size="151" maxlength="255" labelcols="1" cols="1"/> |
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<field name="other" label="Other" type="textarea" columns="151" labelcols="1" cols="1"/> |
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<field name="duration" label="Duration" type="textfield" size="140" maxlength="255" labelcols="1" cols="1"/> |
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</section> |
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<section name="objective" label="Objective"> |
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<field name="exam" label="Exam" type="checkbox_combo_list" list="Urinary_Exam" size="140" labelcols="1" cols="1"/> |
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</section> |
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<section name="assessment" label="Assessment"> |
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<field name="diagnosis" label="Diagnosis" type="checkbox_combo_list" list="Urinary_Diagnosis" size="140" labelcols="1" cols="1"/> |
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</section> |
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<section name="plan" label="Plan"> |
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<field name="plan" label="Plan" type="checkbox_combo_list" list="Urinary_Plans" size="140" labelcols="1" cols="1"/> |
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</section> |
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</manual> |
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<list id="Urinary_Complaints" name="Urinary_Complaints" label="Urinary Complaints" type="standard" import="yes"> |
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<listitem id='1' label="Frequency" order='1'>Frequency</listitem> |
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<listitem id='2' label="Urgency" order='2'>Urgency</listitem> |
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<listitem id='3' label="Incontinence" order='3'>Incontinence</listitem> |
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<listitem id='4' label="Dysuria" order='4'>Dysuria</listitem> |
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<listitem id='5' label="Other" order='5'>Other</listitem> |
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</list> |
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<list id="Urinary_Exam" name="Urinary_Exam" label="Urinary Exam" |
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type="standard" import="yes"> |
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<listitem id='1' label="Vulvar" order="1">"Vulvar"</listitem> |
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<listitem id='2' label="Vaginal" order="2">Vaginal</listitem> |
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<listitem id='3' label="Cervix" order="3">Cervix</listitem> |
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<listitem id='4' label="Uterus" order="4">Uterus</listitem> |
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<listitem id='5' label="Adnexae" order="5">Adnexae</listitem> |
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<listitem id='6' label="Rectal" order="6">Rectal</listitem> |
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<listitem id='7' label="Other" order="7">Other</listitem> |
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</list> |
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<list id="Urinary_Diagnosis" name="Urinary_Diagnosis" label="Urinary Diagnosis" type="standard" import="yes"> |
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<listitem id='1' label="UTI" order="1">UTI</listitem> |
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<listitem id='2' label="Hematuria" order="2">Hematuria</listitem> |
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<listitem id='3' label="Chronic/Recurrent Cystitis" order="3">Chronic/Recurrent Cystitis</listitem> |
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<listitem id='4' label="Duration" order="4">Duration</listitem> |
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<listitem id='5' label="OAB (Overactive Bladder)" order="5">OAB (Overactive Bladder)</listitem> |
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<listitem id='6' label="Other" order="6">Other</listitem> |
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</list> |
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<list id="Urinary_Plans" name="Urinary_Plans" label="Urinary Plans" type="standard" import="yes"> |
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<listitem id='1' label="Antibiotics" order ="1">Antibiotics</listitem> |
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<listitem id='2' label="Urine Cultire and Sensitivity" order ="2">Urine Cultire and Sensitivity</listitem> |
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<listitem id='3' label="Cystoscopy and Cystometrogram" order ="3">Cystoscopy and Cystometrogram</listitem> |
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<listitem id='4' label="Anticholinergic" order ="4">Anticholinergic</listitem> |
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<listitem id='5' label="Behavior Modification" order ="5">Behavior Modification</listitem> |
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<listitem id='6' label="Other" order ="6">Other</listitem> |
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</list> |
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</form> |