A | B | C | D | E | F | G | H | |
---|---|---|---|---|---|---|---|---|
1 | type | name | label | hint | appearance | relevant | constraint | constraint_message |
2 | ||||||||
3 | today | today | ||||||
4 | deviceid | device_id | ||||||
5 | phonenumber | phone_number | ||||||
6 | ||||||||
7 | begin group | group1 | 1 | |||||
8 | text | facility_name | 1.1 Facility Name | w4 | ||||
9 | select_one facility_type | facility_type | 1.2 Facility Type | w2 horizontal | ||||
10 | integer | case_id_number | 1.3 Case Identification Number | w2 | ||||
11 | date | postmortem_date | 1.4 Postmortem Exam Date | w2 | ||||
12 | select_one yes_no | autopsy_performed | 1.5 Internal Autopsy Performed? | w2 horizontal | ||||
13 | integer | age | 1.6 Deceased Age | w1 | ||||
14 | select_one age_units | age_unit | Select age unit | w1 horizontal | ${age} <= 23 or ${age} = '' or . != 'months' | Enter age in years if older than 23 months. | ||
15 | select_one sex | sex | 1.7 Deceased Sex | w2 horizontal | ||||
16 | end group | |||||||
17 | ||||||||
18 | begin group | group2 | 2 | |||||
19 | date | date_injury | 2.1 Date of Injury | w2 | ||||
20 | date | date_death | 2.2 Date of Death | w2 | ||||
21 | end group | |||||||
22 | ||||||||
23 | begin group | group3 | 3 | |||||
24 | select_one injury_place | injury_place | 3.1 Place of Injury Occurrence | w3 horizontal | ||||
25 | text | injury_place_other | Specify Other: | w1 | ${injury_place} = 'other' | |||
26 | select_one death_place | death_place | 3.2 Place of Death Occurrence | w2 horizontal | ||||
27 | text | death_place_other | Specify Other: | w1 | ${death_place} = 'other' | |||
28 | end group | |||||||
29 | ||||||||
30 | begin group | group4 | 4 | w5 | ||||
31 | select_one intent | intent | 4.1 Apparent Intent | w5 horizontal | ||||
32 | select_one mechanism | mechanism | 4.2 Mechanism of Injury | w5 horizontal | ||||
33 | select_one transport_mode | transport_mode | Mode of Transport | w5 horizontal | ${mechanism} = 'rti' | |||
34 | select_one counter_part | counter_part | Counter Part | w3 horizontal | ${mechanism} = 'rti' | |||
35 | end group | |||||||
36 | ||||||||
37 | begin group | group5 | 5 | |||||
38 | text | narrative | Incident Summary Narative | Describe the cause, nature and circumstances of the injury (from the autopsy report, police records, and/or bystander reports). | multiline | |||
39 | end group |