-
Notifications
You must be signed in to change notification settings - Fork 16
/
Copy pathLife style_20240330032617_en.html
121 lines (121 loc) · 11.2 KB
/
Life style_20240330032617_en.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
<!doctype html>
<html lang="en">
<head>
<meta name="viewport" content="width=device-width, initial-scale=1" /><!-- simple style -->
<link rel="stylesheet" href="/static/style.css" />
<style>
.form-item {
padding-left: 1em;
margin-bottom: 0.5em;
}
</style><!-- boostrap style -->
<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" />
<link rel="stylesheet" href="https://cdn.jsdelivr.net/npm/[email protected]/font/bootstrap-icons.css" />
</head>
<body>
<form>
<h1 class="h3">Life style</h1>
<input type="hidden" name="template_id" value="Life style" />
<div class="DV_TEXT md-3 form-item" data-tpath="/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/name/value" data-archetype="openEHR-EHR-COMPOSITION.questionnaire.v1" data-path="/name/value" value="Life style" />
</div>
<div class="ADMIN_ENTRY form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]">
<label class="form-label">Questionnaire question Q0001</label>
<div class="ELEMENT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]">
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/name/value" value="Do you smoke?" />
</div>
<div class="DV_CODED_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value">
<select class="DV_CODED_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value/defining_code" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/value/defining_code">
<option value=""></option>
<option value="A0001">yes</option>
<option value="A0002">no</option>
</select>
</div>
</div>
</div>
<div class="ADMIN_ENTRY form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]">
<label class="form-label">Questionnaire question Q0002</label>
<div class="ELEMENT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]">
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/name/value" value="Sleeping quality" />
</div>
<div class="DV_CODED_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value">
<select class="DV_CODED_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value/defining_code" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/value/defining_code">
<option value=""></option>
<option value="A0003">good</option>
<option value="A0004">acceptable</option>
<option value="A0005">poor</option>
</select>
</div>
</div>
</div>
<div class="ADMIN_ENTRY form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]">
<label class="form-label">Questionnaire question Q0003</label>
<div class="ELEMENT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]">
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/name/value" value="Do you usually take naps during the day?" />
</div>
<div class="DV_CODED_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value">
<select class="DV_CODED_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value/defining_code" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/value/defining_code">
<option value=""></option>
<option value="A0006">yes</option>
<option value="A0007">no</option>
</select>
</div>
</div>
</div>
<div class="ADMIN_ENTRY form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]">
<label class="form-label">Questionnaire question Q0004</label>
<div class="ELEMENT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]">
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/name/value" value="Do you exercise regularly?" />
</div>
<div class="DV_CODED_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value">
<select class="DV_CODED_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value/defining_code" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/value/defining_code">
<option value=""></option>
<option value="A0008">yes</option>
<option value="A0009">no</option>
</select>
</div>
</div>
</div>
<div class="ADMIN_ENTRY form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]">
<label class="form-label">Questionnaire question Q0005</label>
<div class="ELEMENT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]">
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/name/value" value="How much do you exercise and what kind of exercise do you do?" />
</div>
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value">
<textarea class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/value/value"></textarea>
</div>
</div>
</div>
<div class="ADMIN_ENTRY form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]">
<label class="form-label">Questionnaire question Q0006</label>
<div class="ELEMENT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]">
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/name/value" value="What do you usually eat at these times of the day?" />
</div>
</div>
</div>
<div class="ADMIN_ENTRY form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]">
<label class="form-label">Questionnaire question Q0013</label>
<div class="ELEMENT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]">
<div class="DV_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name">
<input type="text" class="DV_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/name/value" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/name/value" value="When do you feel most hungry?" />
</div>
<div class="DV_CODED_TEXT md-3 form-item" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value">
<select class="DV_CODED_TEXT form-control" data-tpath="/content[archetype_id=openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1]/data[at0001]/items[at0002]/value/defining_code" data-archetype="openEHR-EHR-ADMIN_ENTRY.questionnaire_question.v1" data-path="/data[at0001]/items[at0002]/value/defining_code">
<option value=""></option>
<option value="A0010">Morning</option>
<option value="A0011">Noon</option>
<option value="A0012">Mid Afternoon</option>
<option value="A0013">Late Evening</option>
</select>
</div>
</div>
</div>
</form>
</body>
</html>