MI | Update sight test form #433

Signed-off-by: mib.iqbal <[email protected]>

opensrp-sdidtk/src/main/assets/www/form/tes_daya_lihat/form.json

@@ -0,0 +1 @@
+{"name":"tes_daya_lihat","title":"Tes Daya Lihat","sms_keyword":"tes_daya_lihat","default_language":"Bahasa","instance":{"encounter_type":"Tes Daya Lihat"},"version":"201703310711","id_string":"tes_daya_lihat_1","type":"survey","children":[{"instance":{"openmrs_entity_id":"encounter_start","openmrs_entity":"encounter"},"type":"start","name":"start"},{"instance":{"openmrs_entity_id":"encounter_date","openmrs_entity":"encounter"},"type":"today","name":"today"},{"type":"deviceid","name":"deviceid"},{"type":"simserial","name":"simserial"},{"type":"phonenumber","name":"phonenumber"},{"type":"hidden","name":"Village"},{"type":"hidden","name":"Sub-village"},{"type":"note","name":"generated_note_name_10","label":{"Bahasa":"Desa : ${Village}","English":"Desa : ${Village}"}},{"type":"note","name":"generated_note_name_11","label":{"Bahasa":"Dusun : ${Sub-village}","English":"Dusun : ${Sub-village}"}},{"bind":{"calculate":"${Village}"},"type":"hidden","name":"existing_location","instance":{"openmrs_entity_id":"location_id","openmrs_entity":"encounter"}},{"bind":{"calculate":"${Village}"},"type":"calculate","name":"desa","instance":{"openmrs_entity_parent":"usual_residence","openmrs_entity_id":"cityVillage","openmrs_entity":"person_address"}},{"instance":{"openmrs_entity_id":"160753AAAAAAAAAAAAAAAAAAAAAAAAAA","openmrs_entity":"Concept"},"type":"date","name":"sight_test_date","label":{"Bahasa":"Tanggal Entry","English":"Entry Date"}},{"control":{"appearance":"horizontal-compact"},"name":"daya_lihat","label":{"Bahasa":"Hasil Tes Daya Lihat","English":"Visual Assessment Result"},"instance":{"openmrs_entity_id":"160348AAAAAAAAAAAAAAAAAAAAAAAAAA","openmrs_entity":"Concept"},"type":"select one","children":[{"instance":{"openmrs_code":"1115AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"normal","label":{"Bahasa":"Normal","English":"Normal"}},{"instance":{"openmrs_code":"1116AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"ada_gangguan","label":{"Bahasa":"Curiga ada gangguan","English":"Suspected of development disorder"}}]},{"control":{"appearance":"multiline"},"instance":{"openmrs_entity_id":"160716AAAAAAAAAAAAAAAAAAAAAAAAAA","openmrs_entity":"Concept"},"type":"text","name":"kesimpulan","label":{"Bahasa":"__KESIMPULAN__","English":"__SUMMARY__"}},{"instance":{"openmrs_entity":"n/a"},"type":"note","name":"tindakan_intervensi","label":{"Bahasa":"__TINDAKAN INTERVENSI__","English":"__INTERVENTION MEASURE__"}},{"control":{"appearance":"horizontal"},"name":"konseling_stimulasi","label":{"Bahasa":"Konseling stimulasi bagi ibu:","English":"Stimulation consultation for the mother"},"instance":{"openmrs_entity_id":"1651AAAAAAAAAAAAAAAAAAAAAAAAAAAA","openmrs_entity":"Concept"},"type":"select one","children":[{"instance":{"openmrs_code":"1065AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"diberikan","label":{"Bahasa":"Diberikan","English":"Received"}},{"instance":{"openmrs_code":"1066AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"tidak_diberikan","label":{"Bahasa":"Tidak diberikan","English":"Not received"}}]},{"control":{"appearance":"multiline"},"instance":{"openmrs_entity_id":"162165AAAAAAAAAAAAAAAAAAAAAAAAAA","openmrs_entity":"Concept"},"type":"text","name":"tindakan_lain","label":{"Bahasa":"Tindakan pengobatan lain","English":"Other measure:"}},{"control":{"appearance":"horizontal"},"name":"rujukan","label":{"Bahasa":"Apakah anak dirujuk?","English":"Is the child referred to other facility?"},"instance":{"openmrs_entity":"n/a"},"type":"select one","children":[{"instance":{"openmrs_code":"1065AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"ya","label":{"Bahasa":"Ya","English":"Yes"}},{"instance":{"openmrs_code":"1066AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"tidak","label":{"Bahasa":"Tidak","English":"No"}}]},{"instance":{"openmrs_entity_id":"161562AAAAAAAAAAAAAAAAAAAAAAAAAA","openmrs_entity":"Concept"},"type":"text","name":"dirujuk_ke","label":{"Bahasa":"Dirujuk ke","English":"Place of referral"}},{"control":{"appearance":"horizontal"},"name":"surat_rujukan","label":{"Bahasa":"Ada surat rujukan?","English":"Referral letter"},"instance":{"openmrs_entity":"n/a"},"type":"select one","children":[{"instance":{"openmrs_code":"1065AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"ya","label":{"Bahasa":"Ya","English":"Yes"}},{"instance":{"openmrs_code":"1066AAAAAAAAAAAAAAAAAAAAAAAAAAAA"},"name":"tidak","label":{"Bahasa":"Tidak","English":"No"}}]},{"instance":{"openmrs_entity_id":"encounter_end","openmrs_entity":"encounter"},"type":"end","name":"end"},{"control":{"bodyless":true},"type":"group","children":[{"bind":{"readonly":"true()","calculate":"concat('uuid:', uuid())"},"type":"calculate","name":"instanceID"}],"name":"meta"}]}