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Sample form

Here is an example of how to use different controls to create a form that can be linked to any collection protocol.

Sample Form 

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Patient Demographics and Clinical History

A.     Demographics Information

  1. Health Card #
  2. Chart#

B.      Social History

  1. Do you exercise? How often?
  2. Do you smoke? How often?
  3. Do you drink? How often?
  4. Do you take drugs? How often?

C.      Physical Exam Findings

      HT:                                 WT:                        BMI:                      Heart Rate:

D.     Clinical Data (Sub Form)

      Please select if you have ever diagnosed with any of the following conditions:

      1. Thyroid

      2. Arthritis

      3. Lupus

      4. Breast cancer

      5. Ovarian Cancer

      6. Genetic Abnormalities

      7. Sexually Transmitted Diseases (STDs)

      8. Abdominal Pain

      Any medication that are taking for each diagnosis?

      Upload health records

E.      Past Medical History

      Please explain if you had any previous surgery?

      Please explain if you had any medical illnesses or psychiatric conditions?

      Please Mark if you have allergies to any of the following options? Mark all that applies

      Nuts

      Iodine

      Latex

F.      Record of the date and personnel who filled out the form

Creating a Form

Refer 'How to create a form?' section of the wiki page to create a form.

Adding fields using different controls

E.g. Create a custom form 'Patient Demographics and Clinical History' mentioned above. Refer 'How to add controls to a form?' section of the wiki page for adding different controls.

A. Demographics Information

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  1. Adding a note- Demographics Information:

    To add a title to this section, click on 'Note' and fill up the information. 


  2. Adding a numeric field- Health Card Number:

    To add field 'Health Card Number', click on Add/Edit Control and select 'Numeric'. Fill up the information and click on 'Add Control to Form'.


  3. Making fields mandatory and using 'Copy' field feature- Chart Number:

    To add Chart number, click on the 'Numeric' card under 'Add/Edit Control. You can also copy the control you created for step 1 by clicking on 'Copy'.
    Select the 'Field Placement' of the new control you wish to add. 

    By selecting the 'Mandatory' option will make data entry for this field as a required.

B. Social History 

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  1. Adding a radio button field- Do you Exercise?:

    To add questions for this section, use the Radio Button control as this is a Yes/No question with only two options to select from.
  2. Adding a numeric field- How often do you exercise?:

    Use 'Numeric' control to add the frequency of each task.
  3. Similarly, add other fields of social history

C. Physical Exam Findings

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Adding fields in the same row  HT, WT, BMI & Heart Rate:

In order to add measurements for height, weight, BMI, and heart rate use 'Numeric' control and select 'Field Placement' as 'Same Row' so that they appear in the same line.

Calculated fields is not a feature currently, for example, to automatically calculate BMI based on height and weight. This is in the roadmap to support.

D. Clinical Data

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  1. Adding sub-form: 
    Under a form record, the user might need to enter multiple medical conditions and a corresponding list of medications & health record. In order to do this, the user can create a sub-form. Click on 'Sub Form' to add a title to this section.



  2. Adding a Dropdown field with the list of values- Health Condition:

    To add attributes under this, select the subform from the list on the right. Select 'Drop Down' to add a list of health conditions that the user can select from. When 'Drop down' is selected, user can add values that should appear under 'Permissible values' section. 

    For multiple condition values, you can also create a text document or a CSV file with all of the values and upload it rather than entering one by one. Refer to 'How to upload permissible values' section of the wiki page for more details.

  3. Large comments field Medications:

    To add a list of medications like a doctor note, click on the sub form and use 'Text Area' control.


  4. Upload file field Health Records:

    Select subform and click on 'Upload File' to be able to upload any documents for the health record.

E. Past Medical History

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  1. Adding more fields to the main form Please explain if you had any previous surgery?:

    To add sections to the original form, make sure to click on the form name on top of the left tree. Use 'String Text Box' for adding any explanation of past conditions/procedure.



  2. Adding 'Multiple Select' field Any Allergies? Mark all that applies: 

    Drop down allows to choose only one value, if you want to select multiple values under the same field, 'Multiple Select' control can be used. 
    Select 'Multiple Select' from the attribute bar to add a list of allergic items. This will provide the user with the ability to select multiple options if applicable

    If a value needs to be made as default, select the appropriate radio button under the list of values.

F. Record of Date and Personnel

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  1. Adding a date field Date of Submission:

    To keep track of the date that a form was submitted, select 'Date Picker' from the list of attributes.


  2. Including standard OpenSpecimen fields within custom forms User Dropdown:

    Control type 'Fancy Control' helps to include fields already existing in OpenSpecimen. For example, to include list of users, sites, etc. 
    To add personnel, select 'Fancy Control' and select 'User Dropdown' under the fancy control field.

    This will include the list of users automatically created under 'Users' feature of OpenSpecimen. 

Form Preview

Click on 'Preview' to see how the form looks like.

 Click here for form preview...






Got feedback or spotted a mistake?

Leave a comment at the end of this page or email contact@krishagni.com