XLSForm

survey#

type

name

label

hint

relevant

constraint

select_multiple medical_issues

what_issues

Have you experienced any of the following?

Select all that apply.

select_multiple cancer_types

what_cancer

What type of cancer have you experienced?

Select all that apply.

selected(${what_issues}, 'cancer')

select_multiple diabetes_types

what_diabetes

What type of diabetes do you have?

Select all that apply.

selected(${what_issues}, 'diabetes')

begin_group

blood_pressure

Blood pressure reading

selected(${what_issues}, 'hypertension')

integer

systolic_bp

Systolic

. > 40 and . < 400

integer

diastolic_bp

Diastolic

. >= 20 and . <= 200

end_group

text

other_health

List other issues.

selected(${what_issues}, 'other')

note

after_health_note

This note is after all health questions.

choices#

list_name

name

label

medical_issues

cancer

Cancer

medical_issues

diabetes

Diabetes

medical_issues

hypertension

Hypertension

medical_issues

other

Other

cancer_types

lung

Lung cancer

cancer_types

skin

Skin cancer

cancer_types

prostate

Prostate cancer

cancer_types

breast

Breast cancer

cancer_types

other

Other

diabetes_types

type_1

Type 1 (Insulin dependent)

diabetes_types

type_2

Type 2 (Insulin resistant)

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