UNPKG

medic-enketo-xslt

Version:

XSL stylesheets for the Enketo XForm transformation to be run client-side in a web browser

13 lines (8 loc) 10.3 kB
<form autocomplete="off" novalidate="novalidate" class="or clearfix pages" dir="ltr" id="PREG"><!--This form was created by transforming a OpenRosa-flavored (X)Form using an XSL stylesheet created by Enketo LLC.--><section class="form-logo"> </section><h3 dir="auto" id="form-title">New Pregnancy</h3> <label class="question non-select or-appearance-numbers "><span lang="" class="question-label active">Person's ID</span><span class="required">*</span><input type="text" name="/pregnancy/person_id" data-required="true()" data-type-xml="string"/><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label> <fieldset class="question simple-select "><fieldset><legend><span lang="" class="question-label active">Ask the mother if she has any of the following risk factors</span><span class="required">*</span></legend><div class="option-wrapper"><label class=""><input type="checkbox" name="/pregnancy/risk_factors" value="r1" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Is this your first pregancy?</span></label><label class=""><input type="checkbox" name="/pregnancy/risk_factors" value="r2" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">How many children do you have? (Tick checkbox if more than 4)</span></label><label class=""><input type="checkbox" name="/pregnancy/risk_factors" value="r3" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Was your last baby born less than 1 year before?</span></label><label class=""><input type="checkbox" name="/pregnancy/risk_factors" value="r4" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Have you had any previous miscarriages?</span></label><label class=""><input type="checkbox" name="/pregnancy/risk_factors" value="r5" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Haver you had any previous difficulties in childbirth?</span></label><label class=""><input type="checkbox" name="/pregnancy/risk_factors" value="r6" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Do you have any of the following conditions? HIV, heart conditions, asthma, high blood pressure?</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset> <fieldset class="question simple-select "><fieldset><legend><span lang="" class="question-label active">Review danger signs with the mother and remind her to look for these danger signs and go to a clinic health center immediately if she notices any of them</span><span class="required">*</span></legend><div class="option-wrapper"><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d1" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Pain, pressure or cramping in abdomen</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d2" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Bleeding or fluid leaking from vagina or vaginal discharge with bad odour</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d3" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Sever nausea or vomiting</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d4" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Fever of 38 degrees or higher</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d5" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Severe headache or new, blurry vision problems</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d6" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Sudden weight gain or severe selling of feet, ankles, face, or hands</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d7" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Less movement and kicking from the baby</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d8" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Blood in the urine or painful, burning urination</span></label><label class=""><input type="checkbox" name="/pregnancy/danger_signs" value="d9" data-required="true()" data-type-xml="select"/><span lang="" class="option-label active">Diarrhea that doesn't go away</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset> <section class="or-group or-appearance-field-list " name="/pregnancy/group_lmp"><h4><span lang="" class="question-label active">Last menstrual period</span></h4><fieldset class="question simple-select "><fieldset><legend><span lang="" class="question-label active">Date of last cycle unknown?</span><span class="required">*</span></legend><div class="option-wrapper"><label class=""><input type="radio" name="/pregnancy/group_lmp/lmp_method" data-name="/pregnancy/group_lmp/lmp_method" value="date" data-required="true()" data-type-xml="select1"/><span lang="" class="option-label active">Use approximate date of last cycle</span></label><label class=""><input type="radio" name="/pregnancy/group_lmp/lmp_method" data-name="/pregnancy/group_lmp/lmp_method" value="approx" data-required="true()" data-type-xml="select1"/><span lang="" class="option-label active">Date of last cycle unknown</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset><label class="question or-branch pre-init non-select "><span lang="" class="question-label active">Start date of last cycle</span><span class="required">*</span><input type="date" name="/pregnancy/group_lmp/lmp_date" data-required="true()" data-constraint=".&lt;today()" data-relevant="selected( /pregnancy/group_lmp/lmp_method ,'date')" data-type-xml="date"/><span lang="" class="or-constraint-msg active">Date must be before today</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><fieldset class="question simple-select or-branch pre-init "><fieldset><legend><span lang="" class="question-label active">Approximate start date of last cycle</span><span class="required">*</span></legend><div class="option-wrapper"><label class=""><input type="radio" name="/pregnancy/group_lmp/lmp_approx" data-name="/pregnancy/group_lmp/lmp_approx" value="61" data-required="true()" data-relevant="selected( /pregnancy/group_lmp/lmp_method ,'approx')" data-type-xml="select1"/><span lang="" class="option-label active">up to 2 months ago</span></label><label class=""><input type="radio" name="/pregnancy/group_lmp/lmp_approx" data-name="/pregnancy/group_lmp/lmp_approx" value="91" data-required="true()" data-relevant="selected( /pregnancy/group_lmp/lmp_method ,'approx')" data-type-xml="select1"/><span lang="" class="option-label active">up to 3 months ago</span></label><label class=""><input type="radio" name="/pregnancy/group_lmp/lmp_approx" data-name="/pregnancy/group_lmp/lmp_approx" value="122" data-required="true()" data-relevant="selected( /pregnancy/group_lmp/lmp_method ,'approx')" data-type-xml="select1"/><span lang="" class="option-label active">up to 4 months ago</span></label><label class=""><input type="radio" name="/pregnancy/group_lmp/lmp_approx" data-name="/pregnancy/group_lmp/lmp_approx" value="183" data-required="true()" data-relevant="selected( /pregnancy/group_lmp/lmp_method ,'approx')" data-type-xml="select1"/><span lang="" class="option-label active">beween 5 to 6 months ago</span></label><label class=""><input type="radio" name="/pregnancy/group_lmp/lmp_approx" data-name="/pregnancy/group_lmp/lmp_approx" value="244" data-required="true()" data-relevant="selected( /pregnancy/group_lmp/lmp_method ,'approx')" data-type-xml="select1"/><span lang="" class="option-label active">beween 7 to 8 months ago</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset></section><!--end of group --> <label class="note non-select "><span lang="" class="question-label active"><p><strong>The estimated delivery date is</strong></p> <p><strong>Remind woman to</strong><ol><li>Take Iron Folate daily</li><li>Attend regular ANC visits</li></ol></p>...</span><input type="text" name="/pregnancy/display_edd" data-type-xml="string" readonly="readonly"/></label> <fieldset id="or-calculated-items" style="display:none;"><label class="calculation non-select "><input type="hidden" name="/pregnancy/lmp" data-calculate="if(selected( /pregnancy/group_lmp/lmp_method ,'date'), /pregnancy/group_lmp/lmp_date ,date-time(decimal-date-time(today()- /pregnancy/group_lmp/lmp_approx )))" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/pregnancy/edd" data-calculate="format-date-time(date-time(decimal-date-time( /pregnancy/lmp )+280),&quot;%b %e, %Y&quot;)" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/pregnancy/meta/instanceID" data-calculate="concat('uuid:', uuid())" data-type-xml="string"/></label></fieldset></form>