"Variable / Field Name","Form Name","Section Header","Field Type","Field Label","Choices, Calculations, OR Slider Labels","Field Note","Text Validation Type OR Show Slider Number","Text Validation Min","Text Validation Max",Identifier?,"Branching Logic (Show field only if...)","Required Field?","Custom Alignment","Question Number (surveys only)","Matrix Group Name","Matrix Ranking?","Field Annotation"
a_record_id,source_of_reporting,,text,"Record ID",,,,,,,,,,,,,
trigger,source_of_reporting,,checkbox,"Check here to trigger data transfer to Research Database - BC ONLY","1, data transfer trigger","each time a record is saved the trigger will send new data to the research database",,,,,,,,,,,
a_site,source_of_reporting,,text,"Site completing DCF",,,,,,,,,,,,,
a_name,source_of_reporting,,text,"Name of individual completing form",,,,,,y,,,,,,,
a_email,source_of_reporting,,text,"Email for follow-up reminder",,,email,,,y,,,,,,,
a_date,source_of_reporting,,text,"Date case report form completed",,,date_dmy,,,,,,,,,,
a_comments,source_of_reporting,,notes,"General comments",,,,,,,,,,,,,
b_consent,maternal_demographics,,radio,"Has the patient signed an informed consent?","0, No - research ethics waiver of consent | 1, Yes",,,,,,,,,,,,
b_consent_date,maternal_demographics,,text,"
",,,date_dmy,,,,"[b_consent] = '1'",,,,,,
b_age,maternal_demographics,,text,"Maternal age at estimated date of delivery (EDD)",,"999 if unknown",number0-100,,,,,,,,,,
b_ethnicity,maternal_demographics,,checkbox,Ethnicity,"1, White / Caucasian | 2, African / Caribbean / Black | 3, Hispanic / Latino | 4, East Asian | 5, South Asian | 6, South East Asian | 7, West Central Asian / Middle Eastern | 8, Indigenous / Aboriginal / First Nations / Métis / Inuit | 998, Other | 999, Unknown",,,,,,,,,,,,
b_ethnicity_other,maternal_demographics,,text,"",,,,,,,"[b_ethnicity(998)] = '1'",,,,,,
b_birthcountry,maternal_demographics,,text,"Maternal country of birth",,"999 if unknown",,,,,,,,,,,
b_employment,maternal_demographics,,radio,"Employment status during pregnancy","1, Employed | 2, Unemployed | 999, Unknown",,,,,,,,,,,,
b_occupation,maternal_demographics,,text,"Current occupation",,"999 if unknown",,,,,,,,,,,
b_industry,maternal_demographics,,text,"Kind of business, industry or service?",,"999 if unknown",,,,,,,,,,,
b_school,maternal_demographics,,text,"No. of school years completed - maternal",,"999 if unknown",number,,,,,,,,,,
b_partner,maternal_demographics,,radio,Partner,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
b_partner_living,maternal_demographics,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[b_partner] = '1'",,RH,,,,
b_residence,maternal_demographics,,dropdown,"Country of residence, if other than Canada","1, Afghanistan | 2, Albania | 3, Algeria | 4, American Samoa | 5, Andorra | 6, Angola | 7, Anguilla | 8, Antigua and Barbuda | 9, Argentina | 10, Armenia | 11, Aruba | 12, Australia | 13, Austria | 14, Azerbaijan | 15, Bahamas, The | 16, Bahrain | 17, Bangladesh | 18, Barbados | 19, Belarus | 20, Belgium | 21, Belize | 22, Benin | 23, Bermuda | 24, Bhutan | 25, Bolivia | 26, Bosnia | 27, Botswana | 28, Bougainville | 29, Brazil | 30, British Indian Ocean | 31, British Virgin Islands | 32, Brunei | 33, Bulgaria | 34, Burkina Faso | 35, Burundi | 36, Cambodia | 37, Cameroon | 38, Canada | 39, Cape Verde Islands | 40, Cayman Islands | 41, Central African Republic | 42, Chad | 43, Chile | 44, China | 45, Colombia | 46, Comoros | 47, Congo, Republic of | 48, Cook Islands | 49, Costa Rica | 50, Cote d'Ivoire | 51, Croatia | 52, Cuba | 53, Cyprus | 54, Czech Republic Denmark | 55, Djibouti | 56, Dominica | 57, Dominican Republic | 58, Ecuador | 59, Egypt | 60, El Salvador | 61, Equatorial Guinea | 62, Eritrea | 63, Estonia | 64, Ethiopia | 65, Faeroe Islands | 66, Falkland Islands | 67, Federated States of Micronesia | 68, Fiji | 69, Finland | 70, France | 71, French Guiana | 72, French Polynesia | 73, Gabon | 74, Gambia, The | 75, Georgia | 76, Germany | 77, Ghana | 78, Gibraltar | 79, Greece | 80, Greenland | 81, Grenada | 82, Guadeloupe | 83, Guam | 84, Guatemala | 85, Guinea | 86, Guinea-Bissau | 87, Guyana | 88, Haiti | 89, Holy See (Vatican City State) | 90, Honduras | 91, Hungary | 92, Iceland | 93, India | 94, Indonesia | 95, Iran | 96, Iraq | 97, Ireland | 98, Israel | 99, Italy | 100, Jamaica | 101, Japan | 102, Jordan | 103, Kazakhstan | 104, Kenya | 105, Kiribati | 106, Korea, Republic of | 107, Kosovo | 108, Kuwait Kyrgyzstan | 109, Laos | 110, Latvia | 111, Lebanon | 112, Lesotho | 113, Liberia | 114, Libya | 115, Liechtenstein | 116, Lithuania | 117, Luxembourg | 118, Macedonia | 119, Madagascar | 120, Malawi | 121, Malaysia | 122, Maldives | 123, Mali | 124, Malta | 125, Martinique | 126, Mauritania | 127, Mauritius | 128, Mayotte | 129, Mexico | 130, Moldova | 131, Monaco | 132, Mongolia | 133, Montenegro | 134, Montserrat | 135, Morocco | 136, Mozambique | 137, Myanmar | 138, Namibia | 139, Nauru | 140, Nepal | 141, Netherlands | 142, Netherlands Antilles | 143, New Caledonia | 144, New Zealand | 145, Nicaragua | 146, Niger | 147, Nigeria | 148, Norway | 149, Oman | 150, Pakistan | 151, Palestine | 152, Panama | 153, Papua New Guinea | 154, Paraguay | 155, Peru | 156, Philippines | 157, Poland | 158, Portugal | 159, Puerto Rico | 160, Qatar | 161, Reunion | 162, Romania | 163, Russia | 164, Rwanda | 165, Saint Barthelemy | 166, Saint Helena Saint Kitts & Nevis | 167, Saint Lucia | 168, Saint Martin | 169, Saint Pierre & Miquelon | 170, Saint Vincent | 171, Samoa | 172, San Marino | 173, Sao Tome & Principe | 174, Saudi Arabia | 175, Senegal | 176, Serbia | 177, Seychelles | 178, Sierra Leone | 179, Singapore | 180, Slovakia | 181, Slovenia | 182, Solomon Islands | 183, Somalia | 184, South Africa | 185, South Sudan | 186, Spain | 187, Sri Lanka | 188, Sudan | 189, Suriname | 190, Swaziland | 191, Sweden | 192, Switzerland | 193, Syria | 194, Tajikistan | 195, Tanzania, | 196, Taiwan | 197, Thailand | 198, Timor Leste | 199, Togo | 200, Tokelau Islands | 201, Tonga | 202, Trinidad & Tobago | 203, Tunisia | 204, Turkey | 205, Turkmenistan | 206, Turks & Caicos Islands | 207, Tuvalu | 208, Uganda | 209, Ukraine | 210, United Arab Emirates | 211, United Kingdom of GB & NI | 212, United States of America | 213, Uruguay | 214, US Virgin Islands | 215, Uzbekistan | 216, Vanuatu | 217, Venezuela | 218, Vietnam | 219, Wallis & Futuna Islands | 220, Yemen | 221, Zambia | 222, Zimbabwe | 998, Other | 999, Unknown",,autocomplete,,,,,,,,,,
b_province,maternal_demographics,,dropdown,"Province of residence","1, Alberta | 2, British Columbia | 3, Manitoba | 4, New Brunswick | 5, Newfoundland and Labrador | 6, Nova Scotia | 7, Ontario | 8, Prince Edward Island | 9, Quebec | 10, Saskatchewan | 999, Unknown",,autocomplete,,,,"[b_residence] = '38'",,,,,,
b_residence_oth,maternal_demographics,,text,"",,"999 if unknown",,,,,"[b_residence] = '998'",,,,,,
b_postalcode,maternal_demographics,,text,"First 3 digits of postal code",,"999 if unknown",3digit_postal,,,,,,RH,,,,
b_comments,maternal_demographics,,notes,"General comments",,,,,,,,,RH,,,,
c_desc,exposure_history,,descriptive,"NOTE: Record all testing information on Maternal and Infant SARS-COV 2 Testing DCFs:
Maternal testing, Infant testing of the INTRAPARTUM DATA COLLECTION FORMS
",,,,,,,,,,,,,
c_travel,exposure_history,,checkbox,Travel,"1,",,,,,,,,RH,,,,
c_travel_number,exposure_history,,text,"",,"999 if unknown",number,,,,"[c_travel(1)] = '1'",,,,,,
c_travel_country1,exposure_history,,text,"",,,,,,,"[c_travel_number] >= 1",,,,,,
c_travel_date1,exposure_history,,text,"",,,date_dmy,,,,"[c_travel_number] >= 1",,,,,,
c_travel_country2,exposure_history,,text,"",,,,,,,"[c_travel_number] >= 2",,,,,,
c_travel_date2,exposure_history,,text,"",,,date_dmy,,,,"[c_travel_number] >= 2",,,,,,
c_travel_country3,exposure_history,,text,"",,,,,,,"[c_travel_number] >= 3",,,,,,
c_travel_date3,exposure_history,,text,"",,,date_dmy,,,,"[c_travel_number] >= 3",,,,,,
c_travel_country4,exposure_history,,text,"",,,,,,,"[c_travel_number] >= 4",,,,,,
c_travel_date4,exposure_history,,text,"",,,date_dmy,,,,"[c_travel_number] >= 4",,,,,,
c_travel_country5,exposure_history,,text,"",,,,,,,"[c_travel_number] >= 5",,,,,,
c_travel_date5,exposure_history,,text,"",,,date_dmy,,,,"[c_travel_number] >= 5",,,,,,
c_travel_country6,exposure_history,,notes,"",,,,,,,"[c_travel_number] >= 6",,,,,,
c_travel_date6,exposure_history,,notes,"",,,,,,,"[c_travel_number] >= 6",,,,,,
c_contact,exposure_history,,checkbox,"Known contact in community ","1,",,,,,,,,,,,,
c_contact_number,exposure_history,,text,"",,"999 if unknown",number,,,,"[c_contact(1)] = '1'",,,,,,
c_contact_date1,exposure_history,,text,"",,,date_dmy,,,,"[c_contact_number] >= 1 and [c_contact_number] <> 999",,,,,,
c_contact_date2,exposure_history,,text,"",,,date_dmy,,,,"[c_contact_number] >= 2 and [c_contact_number] <> 999",,,,,,
c_contact_date3,exposure_history,,text,"",,,date_dmy,,,,"[c_contact_number] >= 3 and [c_contact_number] <> 999",,,,,,
c_contact_date4,exposure_history,,text,"",,,date_dmy,,,,"[c_contact_number] >= 4 and [c_contact_number] <> 999",,,,,,
c_contact_date5,exposure_history,,text,"",,,date_dmy,,,,"[c_contact_number] >= 5 and [c_contact_number] <> 999",,,,,,
c_contact_date6,exposure_history,,notes,"",,,,,,,"[c_contact_number] >= 6 and [c_contact_number] <> 999",,,,,,
c_hcw,exposure_history,,checkbox,"Occupational risk","1,",,,,,,,,,,,,
c_hcw_spec,exposure_history,,text,"",,,,,,,"[c_hcw(1)] = '1'",,,,,,
c_hcw_date1,exposure_history,,text,"",,,date_dmy,,,,"[c_hcw(1)] = '1'",,,,,,
c_hcw_date2,exposure_history,,text,"",,,date_dmy,,,,"[c_hcw_date1] <> ''",,,,,,
c_hcw_date3,exposure_history,,text,"",,,date_dmy,,,,"[c_hcw_date2] <> ''",,,,,,
c_unknown,exposure_history,,checkbox,Unknown,"1,",,,,,,,,,,,,
c_other,exposure_history,,checkbox,Other,"1,",,,,,,,,,,,,
c_other_describe,exposure_history,,notes,"",,,,,,,"[c_other(1)] = '1'",,,,,,
c_other_number,exposure_history,,text,"",,"999 if unknown",number,,,,"[c_other(1)] = '1'",,,,,,
c_other_date1,exposure_history,,text,"",,,date_dmy,,,,"[c_other_number] >= 1 and [c_other_number] <> 999",,,,,,
c_other_date2,exposure_history,,text,"",,,date_dmy,,,,"[c_other_number] >= 2 and [c_other_number] <> 999",,,,,,
c_other_date3,exposure_history,,text,"",,,date_dmy,,,,"[c_other_number] >= 3 and [c_other_number] <> 999",,,,,,
c_other_date4,exposure_history,,text,"",,,date_dmy,,,,"[c_other_number] >= 4 and [c_other_number] <> 999",,,,,,
c_other_date5,exposure_history,,text,"",,,date_dmy,,,,"[c_other_number] >= 5 and [c_other_number] <> 999",,,,,,
c_other_date6,exposure_history,,notes,"",,,,,,,"[c_other_number] >= 6 and [c_other_number] <> 999",,,,,,
c_comments,exposure_history,,notes,Comments,,,,,,,,,,,,,
d_desc,maternal_testing,,descriptive,"NOTE: Please include all maternal SARS-COV-2 testing results, record infant testing on the INTRAPARTUM DATA COLLECTION FORMS
",,,,,,,,,,,,,
d_naso1,maternal_testing,,checkbox,"Nasopharyngeal swab #1","1,",,,,,,,,,,,,
d_naso1_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso1(1)] = '1'",,,,,,
d_naso1_collect_t,maternal_testing,,text,"",,,time,,,,"[d_naso1(1)] = '1'",,,,,,
d_naso1_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso1(1)] = '1'",,,,,,
d_naso1_test,maternal_testing,,text,"",,,,,,,"[d_naso1(1)] = '1'",,,,,,
d_naso1_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_naso1(1)] = '1'",,,,,,
d_naso2,maternal_testing,,checkbox,"Nasopharyngeal swab #2","1,",,,,,,"[d_naso1(1)] = '1'",,,,,,
d_naso2_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso2(1)] = '1'",,,,,,
d_naso2_collect_t,maternal_testing,,text,"",,,time,,,,"[d_naso2(1)] = '1'",,,,,,
d_naso2_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso2(1)] = '1'",,,,,,
d_naso2_test,maternal_testing,,text,"",,,,,,,"[d_naso2(1)] = '1'",,,,,,
d_naso2_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_naso2(1)] = '1'",,,,,,
d_naso3,maternal_testing,,checkbox,"Nasopharyngeal swab #3","1,",,,,,,"[d_naso2(1)] = '1'",,,,,,
d_naso3_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso3(1)] = '1'",,,,,,
d_naso3_collect_t,maternal_testing,,text,"",,,time,,,,"[d_naso3(1)] = '1'",,,,,,
d_naso3_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso3(1)] = '1'",,,,,,
d_naso3_test,maternal_testing,,text,"",,,,,,,"[d_naso3(1)] = '1'",,,,,,
d_naso3_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_naso3(1)] = '1'",,,,,,
d_naso4,maternal_testing,,checkbox,"Nasopharyngeal swab #4","1,",,,,,,"[d_naso3(1)] = '1'",,,,,,
d_naso4_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso4(1)] = '1'",,,,,,
d_naso4_collect_t,maternal_testing,,text,"",,,time,,,,"[d_naso4(1)] = '1'",,,,,,
d_naso4_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_naso4(1)] = '1'",,,,,,
d_naso4_test,maternal_testing,,text,"",,,,,,,"[d_naso4(1)] = '1'",,,,,,
d_naso4_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_naso4(1)] = '1'",,,,,,
d_nasalswab_desc,maternal_testing,,descriptive,"*If more than 4 nasal swabs done, specify under ""Other SARS-COV-2 testing if clinically indicated""",,,,,,,"[d_naso4(1)] = '1'",,,,,,
d_throat,maternal_testing,,checkbox,"Throat swab","1,",,,,,,,,,,,,
d_throat_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_throat(1)] = '1'",,,,,,
d_throat_collect_t,maternal_testing,,text,"",,,time,,,,"[d_throat(1)] = '1'",,,,,,
d_throat_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_throat(1)] = '1'",,,,,,
d_throat_test,maternal_testing,,text,"",,,,,,,"[d_throat(1)] = '1'",,,,,,
d_throat_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_throat(1)] = '1'",,,,,,
d_blood,maternal_testing,,checkbox,Blood,"1,",,,,,,,,,,,,
d_blood_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_blood(1)] = '1'",,,,,,
d_blood_collect_t,maternal_testing,,text,"",,,time,,,,"[d_blood(1)] = '1'",,,,,,
d_blood_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_blood(1)] = '1'",,,,,,
d_blood_test,maternal_testing,,text,"",,,,,,,"[d_blood(1)] = '1'",,,,,,
d_blood_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_blood(1)] = '1'",,,,,,
d_milk,maternal_testing,,checkbox,"Breast milk","1,",,,,,,,,,,,,
d_milk_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_milk(1)] = '1'",,,,,,
d_milk_collect_t,maternal_testing,,text,"",,,time,,,,"[d_milk(1)] = '1'",,,,,,
d_milk_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_milk(1)] = '1'",,,,,,
d_milk_test,maternal_testing,,text,"",,,,,,,"[d_milk(1)] = '1'",,,,,,
d_milk_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_milk(1)] = '1'",,,,,,
d_amnio,maternal_testing,,checkbox,"Amniotic fluid","1,",,,,,,,,,,,,
d_amnio_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_amnio(1)] = '1'",,,,,,
d_amnio_collect_t,maternal_testing,,text,"",,,time,,,,"[d_amnio(1)] = '1'",,,,,,
d_amnio_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_amnio(1)] = '1'",,,,,,
d_amnio_test,maternal_testing,,text,"",,,,,,,"[d_amnio(1)] = '1'",,,,,,
d_amnio_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_amnio(1)] = '1'",,,,,,
d_igm,maternal_testing,,checkbox,"Serology - IgM","1,",,,,,,,,,,,,
d_igm_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_igm(1)] = '1'",,,,,,
d_igm_collect_t,maternal_testing,,text,"",,,time,,,,"[d_igm(1)] = '1'",,,,,,
d_igm_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_igm(1)] = '1'",,,,,,
d_igm_test,maternal_testing,,text,"",,,,,,,"[d_igm(1)] = '1'",,,,,,
d_igm_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_igm(1)] = '1'",,,,,,
d_igg,maternal_testing,,checkbox,"Serology - IgG","1,",,,,,,,,,,,,
d_igg_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_igg(1)] = '1'",,,,,,
d_igg_collect_t,maternal_testing,,text,"",,,time,,,,"[d_igg(1)] = '1'",,,,,,
d_igg_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_igg(1)] = '1'",,,,,,
d_igg_test,maternal_testing,,text,"",,,,,,,"[d_igg(1)] = '1'",,,,,,
d_igg_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_igg(1)] = '1'",,,,,,
d_other,maternal_testing,,checkbox,"Other SARS-COV-2 testing, if clinically indicated","1,",,,,,,,,,,,,
d_other_spec,maternal_testing,,text,"",,,,,,,"[d_other(1)] = '1'",,,,,,
d_other_collect,maternal_testing,,text,"",,,date_dmy,,,,"[d_other(1)] = '1'",,,,,,
d_other_collect_t,maternal_testing,,text,"",,,time,,,,"[d_other(1)] = '1'",,,,,,
d_other_lab,maternal_testing,,text,"",,,date_dmy,,,,"[d_other(1)] = '1'",,,,,,
d_other_test,maternal_testing,,text,"",,,,,,,"[d_other(1)] = '1'",,,,,,
d_other_result,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_other(1)] = '1'",,,,,,
d_other_2,maternal_testing,,checkbox,"Other SARS-COV-2 testing, if clinically indicated","1,",,,,,,"[d_other(1)] = '1'",,,,,,
d_other_spec_2,maternal_testing,,text,"",,,,,,,"[d_other_2(1)] = '1'",,,,,,
d_other_collect_2,maternal_testing,,text,"",,,date_dmy,,,,"[d_other_2(1)] = '1'",,,,,,
d_other_collect_t_2,maternal_testing,,text,"",,,time,,,,"[d_other_2(1)] = '1'",,,,,,
d_other_lab_2,maternal_testing,,text,"",,,date_dmy,,,,"[d_other_2(1)] = '1'",,,,,,
d_other_test_2,maternal_testing,,text,"",,,,,,,"[d_other_2(1)] = '1'",,,,,,
d_other_result_2,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_other_2(1)] = '1'",,,,,,
d_other_3,maternal_testing,,checkbox,"Other SARS-COV-2 testing, if clinically indicated","1,",,,,,,"[d_other_2(1)] = '1'",,,,,,
d_other_spec_3,maternal_testing,,text,"",,,,,,,"[d_other_3(1)] = '1'",,,,,,
d_other_collect_3,maternal_testing,,text,"",,,date_dmy,,,,"[d_other_3(1)] = '1'",,,,,,
d_other_collect_t_3,maternal_testing,,text,"",,,time,,,,"[d_other_3(1)] = '1'",,,,,,
d_other_lab_3,maternal_testing,,text,"",,,date_dmy,,,,"[d_other_3(1)] = '1'",,,,,,
d_other_test_3,maternal_testing,,text,"",,,,,,,"[d_other_3(1)] = '1'",,,,,,
d_other_result_3,maternal_testing,,dropdown,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[d_other_3(1)] = '1'",,,,,,
d_flu,maternal_testing,"Other tests performed?",radio,Influenza,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
d_flu_date,maternal_testing,,text,"",,,date_dmy,,,,"[d_flu] = '1'",,RH,,,,
d_flu_pos,maternal_testing,,radio,"","1, Postitive | 0, Negative | 999, Unknown",,,,,,"[d_flu] = '1'",,RH,,,,
d_flu_pos_spec,maternal_testing,,radio,"","1, Positive for influenza A | 2, Positive for influenza B | 999, Unknown",,,,,,"[d_flu_pos] = '1'",,,,,,
d_rsv,maternal_testing,,radio,"Respiratory-Syncytial Virus","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
d_rsv_date,maternal_testing,,text,"",,,date_dmy,,,,"[d_rsv] = '1'",,RH,,,,
d_rsv_pos,maternal_testing,,radio,"","1, Postitive | 0, Negative | 999, Unknown",,,,,,"[d_rsv] = '1'",,RH,,,,
d_comments,maternal_testing,,notes,"General comments",,,,,,,,,,,,,
e_desc,maternal_clinical_presentation,,descriptive,"NOTE: Please record all symptoms imaging, complications, treatments and medications during follow-up. Record information available and update as necessary.
NOTE: Record all medications and supplements taken for COVID on COVID medications form and other medications on General Medications & Supplements form. Add all SARS-Cov-2 testing to testing DCF for maternal testing and for infant testing on the INTRAPARTUM DATA COLLECTION FORMS
",,,,,,,,,,,,,
e_diagnosis,maternal_clinical_presentation,,text,"Date of COVID diagnosis, if known",,,date_dmy,,,,,,,,,,
e_acquisition,maternal_clinical_presentation,,text,"Estimated date of acquisition, if known ",,,date_dmy,,,,,,,,,,
e_onset,maternal_clinical_presentation,,text,"Illness onset date, if known",,,date_dmy,,,,,,RH,,,,
e_asymptomatic,maternal_clinical_presentation,,radio,"Asymptomatic at presentation?","0, No | 1, Yes",,,,,,,,,,,,
e_fever,maternal_clinical_presentation,"Symptoms during COVID illness episode:",radio,Fever,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_fever_temp,maternal_clinical_presentation,,radio,"","1, < 38°C | 2, 38-39C | 3, > 39°C | 999, Unknown",,,,,,"[e_fever] = '1'",,,,,,
e_cough,maternal_clinical_presentation,,radio,Cough,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_head,maternal_clinical_presentation,,radio,Headache,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_breath,maternal_clinical_presentation,,radio,"Shortness of breath","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_runny,maternal_clinical_presentation,,radio,"Runny nose","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_muscle,maternal_clinical_presentation,,radio,"Muscle pain/myalgia","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_anorexia,maternal_clinical_presentation,,radio,"Anorexia (loss of appetite)","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_diarrhea,maternal_clinical_presentation,,radio,Diarrhea,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_vomit,maternal_clinical_presentation,,radio,Vomiting,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_malaise,maternal_clinical_presentation,,radio,Malaise,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_fatigue,maternal_clinical_presentation,,radio,Fatigue,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_anosmia,maternal_clinical_presentation,,radio,"Anosmia or ageusia (loss of smell or taste)","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_throat,maternal_clinical_presentation,,radio,"Sore throat","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_sputum,maternal_clinical_presentation,,radio,"Sputum production","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_nausea,maternal_clinical_presentation,,radio,Nausea,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_resp,maternal_clinical_presentation,,radio,"Non-specific respiratory symptoms","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_othersx,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_othersx_spec,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx] = '1'",,RH,,,,
e_othersx_2,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx] = '1'",,RH,,,,
e_othersx_spec_2,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_2] = '1'",,RH,,,,
e_othersx_3,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_2] = '1'",,RH,,,,
e_othersx_spec_3,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_3] = '1'",,RH,,,,
e_othersx_4,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_3] = '1'",,RH,,,,
e_othersx_spec_4,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_4] = '1'",,RH,,,,
e_othersx_5,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_4] = '1'",,RH,,,,
e_othersx_spec_5,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_5] = '1'",,RH,,,,
e_othersx_6,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_5] = '1'",,RH,,,,
e_othersx_spec_6,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_6] = '1'",,RH,,,,
e_othersx_7,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_6] = '1'",,RH,,,,
e_othersx_spec_7,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_7] = '1'",,RH,,,,
e_othersx_8,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_7] = '1'",,RH,,,,
e_othersx_spec_8,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_8] = '1'",,RH,,,,
e_othersx_9,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_8] = '1'",,RH,,,,
e_othersx_spec_9,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_9] = '1'",,RH,,,,
e_othersx_10,maternal_clinical_presentation,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[e_othersx_9] = '1'",,RH,,,,
e_othersx_spec_10,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_othersx_10] = '1'",,RH,,,,
e_pneumonia,maternal_clinical_presentation,"COMPLICATIONS (at any time, in pregnancy or postpartum) ",radio,Pneumonia,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_pneumonia_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_pneumonia] = '1'",,,,,,
e_pneumonia_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_pneumonia] = '1'",,,,,,
e_sepsis,maternal_clinical_presentation,,radio,Sepsis,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_sepsis_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_sepsis] = '1'",,,,,,
e_sepsis_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_sepsis] = '1'",,,,,,
e_respfail,maternal_clinical_presentation,,radio,"Respiratory failure","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_respfail_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_respfail] = '1'",,,,,,
e_respfail_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_respfail] = '1'",,,,,,
e_respdist,maternal_clinical_presentation,,radio,"Acute respiratory distress syndrome","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_respdist_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_respdist] = '1'",,,,,,
e_respdist_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_respdist] = '1'",,,,,,
e_heartfail,maternal_clinical_presentation,,radio,"Heart failure","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_heartfail_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_heartfail] = '1'",,,,,,
e_heartfail_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_heartfail] = '1'",,,,,,
e_shock,maternal_clinical_presentation,,radio,"Septic shock","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_shock_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_shock] = '1'",,,,,,
e_shock_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_shock] = '1'",,,,,,
e_coag,maternal_clinical_presentation,,radio,Coagulopathy,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_coag_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_coag] = '1'",,,,,,
e_coag_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_coag] = '1'",,,,,,
e_renal,maternal_clinical_presentation,,radio,"Renal failure","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_renal_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_renal] = '1'",,,,,,
e_renal_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_renal] = '1'",,,,,,
e_liver,maternal_clinical_presentation,,radio,"Liver dysfunction","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_liver_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_liver] = '1'",,,,,,
e_liver_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_liver] = '1'",,,,,,
e_dic,maternal_clinical_presentation,,radio,"Disseminated intravascular coagulopathy","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_dic_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_dic] = '1'",,,,,,
e_dic_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_dic] = '1'",,,,,,
e_hosp,maternal_clinical_presentation,,radio,"Hospital admission
* For those hospitalized, complete hospitalization form","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_hosp_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_hosp] = '1'",,,,,,
e_hosp_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_hosp] = '1'",,,,,,
e_hosp_add1,maternal_clinical_presentation,,checkbox,"","1,",,,,,,"[e_hosp] = '1'",,,,,,
e_hosp_date_2,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_hosp_add1(1)] = '1'",,,,,,
e_hosp_dur_2,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_hosp_add1(1)] = '1'",,,,,,
e_hosp_add2,maternal_clinical_presentation,,checkbox,"","1,",,,,,,"[e_hosp_add1(1)] = '1'",,,,,,
e_hosp_date_3,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_hosp_add2(1)] = '1'",,,,,,
e_hosp_dur_3,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_hosp_add2(1)] = '1'",,,,,,
e_hosp_add3,maternal_clinical_presentation,,checkbox,"","1,",,,,,,"[e_hosp_add2(1)] = '1'",,,,,,
e_hosp_date_4,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_hosp_add3(1)] = '1'",,,,,,
e_hosp_dur_4,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_hosp_add3(1)] = '1'",,,,,,
e_death,maternal_clinical_presentation,,radio,"Maternal death","0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_death_note,maternal_clinical_presentation,,descriptive,"*If yes complete maternal death form
",,,,,,,"[e_death] = '1'",,,,,,
e_compoth,maternal_clinical_presentation,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_asymptomatic] = '0'",,RH,,,,
e_compoth_specify,maternal_clinical_presentation,,text,"",,,,,,,"[e_compoth] = '1'",,RH,,,,
e_compoth_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_compoth] = '1'",,,,,,
e_compoth_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_compoth] = '1'",,,,,,
e_xray,maternal_clinical_presentation,"CHEST IMAGING",radio,"X-ray test performed?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
e_xray_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_xray] = '1'",,RH,,,,
e_xray_result,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_xray] = '1'",,,,,,
e_xray_abnormal,maternal_clinical_presentation,,text,"",,,,,,,"[e_xray_result] = '1'",,,,,,
e_xray_2,maternal_clinical_presentation,,radio,"Second X-ray test performed?","0, No | 1, Yes | 999, Unknown",,,,,,"[e_xray] = '1'",,RH,,,,
e_xray_date_2,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_xray_2] = '1'",,RH,,,,
e_xray_result_2,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_xray_2] = '1'",,,,,,
e_xray_abnormal_2,maternal_clinical_presentation,,text,"",,,,,,,"[e_xray_result_2] = '1'",,,,,,
e_ct,maternal_clinical_presentation,,radio,"CT scan performed?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
e_ct_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_ct] = '1'",,RH,,,,
e_ct_result,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_ct] = '1'",,,,,,
e_ct_abnormal,maternal_clinical_presentation,,text,"",,,,,,,"[e_ct_result] = '1'",,,,,,
e_ct_2,maternal_clinical_presentation,,radio,"Second CT scan performed?","0, No | 1, Yes | 999, Unknown",,,,,,"[e_ct] = '1'",,RH,,,,
e_ct_date_2,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_ct_2] = '1'",,RH,,,,
e_ct_result_2,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_ct_2] = '1'",,,,,,
e_ct_abnormal_2,maternal_clinical_presentation,,text,"",,,,,,,"[e_ct_result_2] = '1'",,,,,,
e_mri,maternal_clinical_presentation,,radio,"MRI performed?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
e_mri_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_mri] = '1'",,RH,,,,
e_mri_result,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_mri] = '1'",,,,,,
e_mri_abnormal,maternal_clinical_presentation,,text,"",,,,,,,"[e_mri_result] = '1'",,,,,,
e_mri_2,maternal_clinical_presentation,,radio,"Second MRI performed?","0, No | 1, Yes | 999, Unknown",,,,,,"[e_mri] = '1'",,RH,,,,
e_mri_date_2,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_mri_2] = '1'",,RH,,,,
e_mri_result_2,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_mri_2] = '1'",,,,,,
e_mri_abnormal_2,maternal_clinical_presentation,,text,"",,,,,,,"[e_mri_result_2] = '1'",,,,,,
e_chest_oth,maternal_clinical_presentation,,radio,"Other chest imaging?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
e_chest_oth_specify,maternal_clinical_presentation,,text,"",,,,,,,"[e_chest_oth] = '1'",,RH,,,,
e_chest_oth_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_chest_oth] = '1'",,RH,,,,
e_chest_oth_result,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_chest_oth] = '1'",,,,,,
e_chest_oth_abnormal,maternal_clinical_presentation,,text,"",,,,,,,"[e_chest_oth_result] = '1'",,,,,,
e_imag_oth,maternal_clinical_presentation,"OTHER IMAGING (non-chest)",radio,"a. ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
e_imag_oth_type,maternal_clinical_presentation,,text,"",,,,,,,"[e_imag_oth] = '1'",,,,,,
e_imag_oth_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_imag_oth] = '1'",,,,,,
e_imag_oth_result,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_imag_oth] = '1'",,,,,,
e_imag_oth_abnormal,maternal_clinical_presentation,,text,"",,,,,,,"[e_imag_oth_result] = '1'",,,,,,
e_imag_oth_2,maternal_clinical_presentation,,radio,b.,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_imag_oth] = '1'",,RH,,,,
e_imag_oth_type_2,maternal_clinical_presentation,,text,"",,,,,,,"[e_imag_oth_2] = '1'",,,,,,
e_imag_oth_date_2,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_imag_oth_2] = '1'",,,,,,
e_imag_oth_result_2,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_imag_oth_2] = '1'",,,,,,
e_imag_oth_abnormal_2,maternal_clinical_presentation,,text,"",,,,,,,"[e_imag_oth_result_2] = '1'",,,,,,
e_imag_oth_3,maternal_clinical_presentation,,radio,c.,"0, No | 1, Yes | 999, Unknown",,,,,,"[e_imag_oth_2] = '1'",,RH,,,,
e_imag_oth_type_3,maternal_clinical_presentation,,text,"",,,,,,,"[e_imag_oth_3] = '1'",,,,,,
e_imag_oth_date_3,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_imag_oth_3] = '1'",,,,,,
e_imag_oth_result_3,maternal_clinical_presentation,,radio,"","1, Abnormal | 0, Normal | 2, Pending | 999, Unknown",,,,,,"[e_imag_oth_3] = '1'",,,,,,
e_imag_oth_abnormal_3,maternal_clinical_presentation,,text,"",,,,,,,"[e_imag_oth_result_3] = '1'",,,,,,
e_treatment,maternal_clinical_presentation,TREATMENT,radio,"Were any of the following treatments performed?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
e_ivig,maternal_clinical_presentation,,checkbox,"Intravenous immunoglobulin","1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_ivig_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_ivig(1)] = '1'",,,,,,
e_ivig_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_ivig(1)] = '1'",,,,,,
e_ivig_dose,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_ivig(1)] = '1'",,,,,,
e_oxygen,maternal_clinical_presentation,,checkbox,"Oxygen (outside of at delivery)","1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_oxygen_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_oxygen(1)] = '1'",,,,,,
e_oxygen_dur,maternal_clinical_presentation,,text,"Duration (days, CUMULATIVE)
",,"999 if unknown",number,,,,"[e_oxygen(1)] = '1'",,,,,,
e_oxygen_max,maternal_clinical_presentation,,text,"Maximal therapy delivered, L per minute
",,"999 if unknown",number,,,,"[e_oxygen(1)] = '1'",,,,,,
e_nasal,maternal_clinical_presentation,,checkbox,"High-flow nasal cannula oxygen therapy","1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_nasal_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_nasal(1)] = '1'",,,,,,
e_nasal_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_nasal(1)] = '1'",,,,,,
e_inv,maternal_clinical_presentation,,checkbox,"Invasive mechanical ventilation","1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_inv_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_inv(1)] = '1'",,,,,,
e_inv_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_inv(1)] = '1'",,,,,,
e_noninv,maternal_clinical_presentation,,checkbox,"Non-invasive mechanical ventilation ","1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_noninv_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_noninv(1)] = '1'",,,,,,
e_noninv_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_noninv(1)] = '1'",,,,,,
e_ecmo,maternal_clinical_presentation,,checkbox,ECMO,"1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_ecmo_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_ecmo(1)] = '1'",,,,,,
e_ecmo_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_ecmo(1)] = '1'",,,,,,
e_renalrep,maternal_clinical_presentation,,checkbox,"Renal replacement therapy ","1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_renalrep_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_renalrep(1)] = '1'",,,,,,
e_renalrep_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_renalrep(1)] = '1'",,,,,,
e_vaso,maternal_clinical_presentation,,checkbox,"Vasopressors ","1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_vaso_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_vaso(1)] = '1'",,,,,,
e_vaso_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_vaso(1)] = '1'",,,,,,
e_tx_other,maternal_clinical_presentation,,checkbox,Other,"1,",,,,,,"[e_treatment] = '1' or [e_treatment] = ''",,,,,,
e_tx_other_specify,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_tx_other(1)] = '1'",,,,,,
e_tx_other_date,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_tx_other(1)] = '1'",,,,,,
e_tx_other_dur,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_tx_other(1)] = '1'",,,,,,
e_tx_other_2,maternal_clinical_presentation,,checkbox,Other,"1,",,,,,,"[e_tx_other(1)] = '1'",,,,,,
e_tx_other_specify_2,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_tx_other_2(1)] = '1'",,,,,,
e_tx_other_date_2,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_tx_other_2(1)] = '1'",,,,,,
e_tx_other_dur_2,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_tx_other_2(1)] = '1'",,,,,,
e_tx_other_3,maternal_clinical_presentation,,checkbox,Other,"1,",,,,,,"[e_tx_other_2(1)] = '1'",,,,,,
e_tx_other_specify_3,maternal_clinical_presentation,,text,"",,"999 if unknown",,,,,"[e_tx_other_3(1)] = '1'",,,,,,
e_tx_other_date_3,maternal_clinical_presentation,,text,"",,,date_dmy,,,,"[e_tx_other_3(1)] = '1'",,,,,,
e_tx_other_dur_3,maternal_clinical_presentation,,text,"",,"999 if unknown",number,,,,"[e_tx_other_3(1)] = '1'",,,,,,
e_comments,maternal_clinical_presentation," ",notes,"General comments",,,,,,,,,,,,,
f_desc,medications_and_natural_health_products,,descriptive,"NOTE: Please record medications, OTC and prescription, and natural health products, taken in pregnancy and birth for COVID-19 here.
Record postpartum COVID medications on postpartum forms.
Record medications for other indications on General Medications form.
",,,,,,,,,,,,,
f_otc_none,medications_and_natural_health_products,"Over the counter medications",radio,,"0, No over the counter medications | 999, Unknown",,,,,,,,LH,,,,
f_otc,medications_and_natural_health_products,,checkbox,"OTC meds","1,",,,,,,"[f_otc_none] = ''",,,,,,
f_otc_aceta,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_otc(1)] = '1'",,,,,,
f_otc_nsaids,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_otc(1)] = '1'",,,,,,
f_otc_nsaids_asp,medications_and_natural_health_products,,checkbox,"Acetylsalicylic acid (Aspirin)
","1,",,,,,,"[f_otc_nsaids(1)] = '1'",,,,,,
f_otc_nsaids_ibu,medications_and_natural_health_products,,checkbox,"Ibuprofen (Advil, Motrin, others)
","1,",,,,,,"[f_otc_nsaids(1)] = '1'",,,,,,
f_otc_nsaids_nap,medications_and_natural_health_products,,checkbox,"Naproxen (Aleve, Naprosyn, other)
","1,",,,,,,"[f_otc_nsaids(1)] = '1'",,,,,,
f_otc_nsaids_oth,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_otc_nsaids(1)] = '1'",,,,,,
f_otc_nsaids_oth_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_otc_nsaids_oth(1)] = '1'",,,,,,
f_otc_nsaids_oth_2,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_otc_nsaids(1)] = '1'",,,,,,
f_otc_nsaids_oth_s_2,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_otc_nsaids_oth_2(1)] = '1'",,,,,,
f_otc_oth1,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_otc(1)] = '1'",,,,,,
f_otc_oth1_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_otc_oth1(1)] = '1'",,,,,,
f_otc_oth2,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_otc(1)] = '1' and [f_otc_oth1(1)] = '1'",,,,,,
f_otc_oth2_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_otc_oth2(1)] = '1'",,,,,,
f_otc_oth3,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_otc(1)] = '1' and [f_otc_oth2(1)] = '1'",,,,,,
f_otc_oth3_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_otc_oth3(1)] = '1'",,,,,,
f_pres_none,medications_and_natural_health_products,"Prescription medications",radio,,"0, No prescription medications | 999, Unknown",,,,,,,,LH,,,,
f_pres_cort,medications_and_natural_health_products,,checkbox,"Corticosteroids (check all taken)
","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_cort_dex,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_cort(1)] = '1'",,,,,,
f_pres_cort_dex_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_cort_dex(1)] = '1'",,,,,,
f_pres_cort_dex_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_dex(1)] = '1'",,,,,,
f_pres_cort_dex_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_dex(1)] = '1'",,,,,,
f_pres_cort_oth,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_cort(1)] = '1'",,,,,,
f_pres_cort_oth_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_oth(1)] = '1'",,,,,,
f_pres_cort_oth_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_cort_oth(1)] = '1'",,,,,,
f_pres_cort_oth_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_oth(1)] = '1'",,,,,,
f_pres_cort_oth_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_oth(1)] = '1'",,,,,,
f_pres_cort_oth_2,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_cort_oth(1)] = '1'",,,,,,
f_pres_cort_oth_s_2,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_oth_2(1)] = '1'",,,,,,
f_pres_cort_oth_ct_2,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_cort_oth_2(1)] = '1'",,,,,,
f_pres_cort_oth_dose_2,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_oth_2(1)] = '1'",,,,,,
f_pres_cort_oth_dur_2,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_cort_oth_2(1)] = '1'",,,,,,
f_pres_ster,medications_and_natural_health_products,,checkbox,"Steroids for fetal lung maturation
","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_ster_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_ster(1)] = '1'",,,,,,
f_pres_ster_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_ster(1)] = '1'",,,,,,
f_pres_ster_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_ster(1)] = '1'",,,,,,
f_pres_ster_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_ster(1)] = '1'",,,,,,
f_pres_chlor,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_chlor_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_chlor(1)] = '1'",,,,,,
f_pres_chlor_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_chlor(1)] = '1'",,,,,,
f_pres_chlor_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_chlor(1)] = '1'",,,,,,
f_pres_chlor_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_chlor(1)] = '1'",,,,,,
f_pres_hydrox,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_hydrox_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_hydrox(1)] = '1'",,,,,,
f_pres_hydrox_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_hydrox(1)] = '1'",,,,,,
f_pres_hydrox_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_hydrox(1)] = '1'",,,,,,
f_pres_hydrox_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_hydrox(1)] = '1'",,,,,,
f_pres_colch,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_colch_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_colch(1)] = '1'",,,,,,
f_pres_colch_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_colch(1)] = '1'",,,,,,
f_pres_colch_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_colch(1)] = '1'",,,,,,
f_pres_av,medications_and_natural_health_products,,checkbox," Antiviral (check all taken)
","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_av_kal,medications_and_natural_health_products,,checkbox,"Kaletra (Lopinavir/Ritonavir)
","1,",,,,,,"[f_pres_av(1)] = '1'",,,,,,
f_pres_av_kal_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_av_kal(1)] = '1'",,,,,,
f_pres_av_kal_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_kal(1)] = '1'",,,,,,
f_pres_av_kal_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_kal(1)] = '1'",,,,,,
f_pres_av_rem,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_av(1)] = '1'",,,,,,
f_pres_av_rem_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_av_rem(1)] = '1'",,,,,,
f_pres_av_rem_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_rem(1)] = '1'",,,,,,
f_pres_av_rem_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_rem(1)] = '1'",,,,,,
f_pres_av_oth1,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_av(1)] = '1'",,,,,,
f_pres_av_oth1_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_oth1(1)] = '1'",,,,,,
f_pres_av_oth1_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_av_oth1(1)] = '1'",,,,,,
f_pres_av_oth1_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_oth1(1)] = '1'",,,,,,
f_pres_av_oth1_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_oth1(1)] = '1'",,,,,,
f_pres_av_oth2,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_av_oth1(1)] = '1'",,,,,,
f_pres_av_oth2_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_oth2(1)] = '1'",,,,,,
f_pres_av_oth2_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_av_oth2(1)] = '1'",,,,,,
f_pres_av_oth2_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_oth2(1)] = '1'",,,,,,
f_pres_av_oth2_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_av_oth2(1)] = '1'",,,,,,
f_pres_ab,medications_and_natural_health_products,,checkbox,"Antibiotics (check all taken)
","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_ab_s1,medications_and_natural_health_products,,text,"",,,,,,,"[f_pres_ab(1)] = '1'",,,,,,
f_pres_ab_1_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_ab_s1] <> ''",,,,,,
f_pres_ab_1_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_ab_s1] <> ''",,,,,,
f_pres_ab_1_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_ab_s1] <> ''",,,,,,
f_pres_ab_s2,medications_and_natural_health_products,,text,"",,,,,,,"[f_pres_ab_s1] <> ''",,,,,,
f_pres_ab_2_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_ab_s2] <> ''",,,,,,
f_pres_ab_2_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_ab_s2] <> ''",,,,,,
f_pres_ab_2_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_ab_s2] <> ''",,,,,,
f_pres_oth1,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_none] = ''",,,,,,
f_pres_oth1_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth1(1)] = '1'",,,,,,
f_pres_oth1_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth1(1)] = '1'",,,,,,
f_pres_oth1_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth1(1)] = '1'",,,,,,
f_pres_oth1_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth1(1)] = '1'",,,,,,
f_pres_oth2,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth1(1)] = '1'",,,,,,
f_pres_oth2_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth2(1)] = '1'",,,,,,
f_pres_oth2_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth2(1)] = '1'",,,,,,
f_pres_oth2_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth2(1)] = '1'",,,,,,
f_pres_oth2_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth2(1)] = '1'",,,,,,
f_pres_oth3,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth2(1)] = '1'",,,,,,
f_pres_oth3_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth3(1)] = '1'",,,,,,
f_pres_oth3_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth3(1)] = '1'",,,,,,
f_pres_oth3_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth3(1)] = '1'",,,,,,
f_pres_oth3_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth3(1)] = '1'",,,,,,
f_pres_oth4,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth3(1)] = '1'",,,,,,
f_pres_oth4_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth4(1)] = '1'",,,,,,
f_pres_oth4_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth4(1)] = '1'",,,,,,
f_pres_oth4_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth4(1)] = '1'",,,,,,
f_pres_oth4_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth4(1)] = '1'",,,,,,
f_pres_oth5,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth4(1)] = '1'",,,,,,
f_pres_oth5_s,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth5(1)] = '1'",,,,,,
f_pres_oth5_ct,medications_and_natural_health_products,,checkbox,"","1,",,,,,,"[f_pres_oth5(1)] = '1'",,,,,,
f_pres_oth5_dose,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth5(1)] = '1'",,,,,,
f_pres_oth5_dur,medications_and_natural_health_products,,text,"",,"999 if unknown",,,,,"[f_pres_oth5(1)] = '1'",,,,,,
f_nat_none,medications_and_natural_health_products,"Natural Health Products",radio,,"0, No natural health products | 999, Unknown",,,,,,,,LH,,,,
f_nat,medications_and_natural_health_products,,checkbox,"Natural health products","1,",,,,,,"[f_nat_none] = ''",,,,,,
f_nat1_s,medications_and_natural_health_products,,text,"",,,,,,,"[f_nat(1)] = '1'",,,,,,
f_nat2_s,medications_and_natural_health_products,,text,"",,,,,,,"[f_nat1_s] <> ''",,,,,,
f_nat3_s,medications_and_natural_health_products,,text,"",,,,,,,"[f_nat2_s] <> ''",,,,,,
f_nat4_s,medications_and_natural_health_products,,text,"",,,,,,,"[f_nat3_s] <> ''",,,,,,
f_comments,medications_and_natural_health_products," ",notes,"General comments",,,,,,,,,,,,,
g_date,hospitalization_1,,text,Date,,,date_dmy,,,,,,,,,,
g_fever,hospitalization_1,"Symptoms at admission (outside of admission for delivery)",radio,Fever,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fever_temp,hospitalization_1,,radio,"","1, < 38°C | 2, 38-39C | 3, > 39°C | 999, Unknown",,,,,,"[g_fever] = '1'",,,,,,
g_cough,hospitalization_1,,radio,Cough,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_head,hospitalization_1,,radio,Headache,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_breath,hospitalization_1,,radio,"Shortness of breath","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_runny,hospitalization_1,,radio,"Runny nose","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_muscle,hospitalization_1,,radio,"Muscle pain/myalgia","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anorexia,hospitalization_1,,radio,"Anorexia (loss of appetite)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_diarrhea,hospitalization_1,,radio,Diarrhea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_vomit,hospitalization_1,,radio,Vomiting,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_malaise,hospitalization_1,,radio,Malaise,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fatigue,hospitalization_1,,radio,Fatigue,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anosmia,hospitalization_1,,radio,"Anosmia or ageusia (loss of smell or taste)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_throat,hospitalization_1,,radio,"Sore throat","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_sputum,hospitalization_1,,radio,"Sputum production","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_nausea,hospitalization_1,,radio,Nausea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_resp,hospitalization_1,,radio,"Non-specific respiratory symptoms","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx,hospitalization_1,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx_spec,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_othersx] = '1'",,RH,,,,
g_othersx_2,hospitalization_1,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[g_othersx] = '1'",,RH,,,,
g_othersx_spec_2,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_othersx_2] = '1'",,RH,,,,
g_icu,hospitalization_1,,radio,"Admitted to ICU?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
g_icu_date,hospitalization_1,,text,"ICU Admission Date",,,date_dmy,,,,"[g_icu] = '1'",,,,,,
g_icu_dur,hospitalization_1,,text,"Duration of Stay (days)",,"999 if unknown",number,,,,"[g_icu] = '1'",,,,,,
g_hightemp,hospitalization_1,,radio,"Highest patient temperature?","1, < 38°C | 2, 38-39°C | 3, >39°C | 999, Unknown",,,,,,,,,,,,
g_bpm,hospitalization_1,,radio,"Maternal heart rate at admission (bpm)","1, < 100 bpm (NORMAL) | 2, 100-110 bpm | 3, 111-120 bpm | 4, >120 bpm | 999, Unknown",,,,,,,,,,,,
g_sysbp,hospitalization_1,,text,"Maternal systolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_diabp,hospitalization_1,,text,"Maternal diastolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_rr,hospitalization_1,,radio,"Respiratory rate at admission (/min)","1, <22/min | 2, 22-34/min | 3, >34/min | 999, Unknown",,,,,,,,,,,,
g_oxysat,hospitalization_1,,text,"Peripheral oxygen saturation at admission (SpO2%)",,"999 if unknown",number,,,,,,RH,,,,
g_alteredmental,hospitalization_1,,radio,"Altered mental status","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg,hospitalization_1,,radio,"ECG at admission","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg_result,hospitalization_1,,radio,"","1, Normal | 0, Abnormal | 999, Unknown",,,,,,"[g_ecg] = '1'",,RH,,,,
g_platelet,hospitalization_1,,radio,"Platelet count - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_platelet_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_platelet] = '0'",,RH,,,,
g_platelet_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_platelet] = '0' or [g_platelet] = '1'",,RH,,,,
g_wbc,hospitalization_1,,radio,"White blood count (WBC) - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_wbc_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_wbc] = '0'",,RH,,,,
g_wbc_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_wbc] = '0' or [g_wbc] = '1'",,RH,,,,
g_haem,hospitalization_1,,radio,"Haemoglobin - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_haem_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_haem] = '0'",,RH,,,,
g_haem_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_haem] = '1' or [g_haem] = '0'",,RH,,,,
g_crp,hospitalization_1,,radio,"CRP - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_crp_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_crp] = '0'",,RH,,,,
g_crp_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_crp] = '1' or [g_crp] = '0'",,RH,,,,
g_lactate,hospitalization_1,,radio,"Lactate dehydrogenase (U/L >245) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_lactate_highlow,hospitalization_1,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_lactate] = '0'",,RH,,,,
g_lactate_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_lactate] = '0'",,RH,,,,
g_lactate_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_lactate] = '1' or [g_lactate] = '0'",,RH,,,,
g_alt,hospitalization_1,,radio,"ALT (U/L >40) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_alt_highlow,hospitalization_1,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_alt] = '0'",,RH,,,,
g_alt_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_alt] = '0'",,RH,,,,
g_alt_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_alt] = '1' or [g_alt] = '0'",,RH,,,,
g_creat,hospitalization_1,,radio,"Creatinine - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_creat_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_creat] = '0'",,RH,,,,
g_creat_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_creat] = '1' or [g_creat] = '0'",,RH,,,,
g_uric,hospitalization_1,,radio,"Uric acid - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_uric_value,hospitalization_1,,text,"",,"999 if unknown",,,,,"[g_uric] = '0'",,RH,,,,
g_uric_date,hospitalization_1,,text,"",,,date_dmy,,,,"[g_uric] = '1' or [g_uric] = '0'",,RH,,,,
g_comments,hospitalization_1,,notes,"General comments",,,,,,,,,RH,,,,
g_date2,hospitalization_2,,text,Date,,,date_dmy,,,,,,,,,,
g_fever2,hospitalization_2,"Symptoms at admission (outside of admission for delivery)",radio,Fever,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fever_temp2,hospitalization_2,,radio,"","1, < 38°C | 2, 38-39C | 3, > 39°C | 999, Unknown",,,,,,"[g_fever2] = '1'",,,,,,
g_cough2,hospitalization_2,,radio,Cough,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_head2,hospitalization_2,,radio,Headache,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_breath2,hospitalization_2,,radio,"Shortness of breath","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_runny2,hospitalization_2,,radio,"Runny nose","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_muscle2,hospitalization_2,,radio,"Muscle pain/myalgia","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anorexia2,hospitalization_2,,radio,"Anorexia (loss of appetite)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_diarrhea2,hospitalization_2,,radio,Diarrhea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_vomit2,hospitalization_2,,radio,Vomiting,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_malaise2,hospitalization_2,,radio,Malaise,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fatigue2,hospitalization_2,,radio,Fatigue,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anosmia2,hospitalization_2,,radio,"Anosmia or ageusia (loss of smell or taste)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_throat2,hospitalization_2,,radio,"Sore throat","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_sputum2,hospitalization_2,,radio,"Sputum production","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_nausea2,hospitalization_2,,radio,Nausea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_resp2,hospitalization_2,,radio,"Non-specific respiratory symptoms","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx2,hospitalization_2,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx_spec2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_othersx2] = '1'",,RH,,,,
g_othersx_22,hospitalization_2,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[g_othersx2] = '1'",,RH,,,,
g_othersx_spec_22,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_othersx_22] = '1'",,RH,,,,
g_icu2,hospitalization_2,,radio,"Admitted to ICU?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
g_icu_date2,hospitalization_2,,text,"ICU Admission Date",,,date_dmy,,,,"[g_icu2] = '1'",,,,,,
g_icu_dur2,hospitalization_2,,text,"Duration of Stay (days)",,"999 if unknown",number,,,,"[g_icu2] = '1'",,,,,,
g_hightemp2,hospitalization_2,,radio,"Highest patient temperature?","1, < 38°C | 2, 38-39°C | 3, >39°C | 999, Unknown",,,,,,,,,,,,
g_bpm2,hospitalization_2,,radio,"Maternal heart rate at admission (bpm)","1, < 100 bpm (NORMAL) | 2, 100-110 bpm | 3, 111-120 bpm | 4, >120 bpm | 999, Unknown",,,,,,,,,,,,
g_sysbp2,hospitalization_2,,text,"Maternal systolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_diabp2,hospitalization_2,,text,"Maternal diastolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_rr2,hospitalization_2,,radio,"Respiratory rate at admission (/min)","1, <22/min | 2, 22-34/min | 3, >34/min | 999, Unknown",,,,,,,,,,,,
g_oxysat2,hospitalization_2,,text,"Peripheral oxygen saturation at admission (SpO2%)",,"999 if unknown",number,,,,,,RH,,,,
g_alteredmental2,hospitalization_2,,radio,"Altered mental status","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg2,hospitalization_2,,radio,"ECG at admission","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg_result2,hospitalization_2,,radio,"","1, Normal | 0, Abnormal | 999, Unknown",,,,,,"[g_ecg2] = '1'",,RH,,,,
g_platelet2,hospitalization_2,,radio,"Platelet count - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_platelet_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_platelet2] = '0'",,RH,,,,
g_platelet_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_platelet2] = '0' or [g_platelet2] = '1'",,RH,,,,
g_wbc2,hospitalization_2,,radio,"White blood count (WBC) - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_wbc_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_wbc2] = '0'",,RH,,,,
g_wbc_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_wbc2] = '0' or [g_wbc2] = '1'",,RH,,,,
g_haem2,hospitalization_2,,radio,"Haemoglobin - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_haem_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_haem2] = '0'",,RH,,,,
g_haem_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_haem2] = '1' or [g_haem2] = '0'",,RH,,,,
g_crp2,hospitalization_2,,radio,"CRP - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_crp_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_crp2] = '0'",,RH,,,,
g_crp_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_crp2] = '1' or [g_crp2] = '0'",,RH,,,,
g_lactate2,hospitalization_2,,radio,"Lactate dehydrogenase (U/L >245) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_lactate_highlow2,hospitalization_2,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_lactate2] = '0'",,RH,,,,
g_lactate_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_lactate2] = '0'",,RH,,,,
g_lactate_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_lactate2] = '1' or [g_lactate2] = '0'",,RH,,,,
g_alt2,hospitalization_2,,radio,"ALT (U/L >40) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_alt_highlow2,hospitalization_2,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_alt2] = '0'",,RH,,,,
g_alt_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_alt2] = '0'",,RH,,,,
g_alt_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_alt2] = '1' or [g_alt2] = '0'",,RH,,,,
g_creat2,hospitalization_2,,radio,"Creatinine - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_creat_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_creat2] = '0'",,RH,,,,
g_creat_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_creat2] = '1' or [g_creat2] = '0'",,RH,,,,
g_uric2,hospitalization_2,,radio,"Uric acid - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_uric_value2,hospitalization_2,,text,"",,"999 if unknown",,,,,"[g_uric2] = '0'",,RH,,,,
g_uric_date2,hospitalization_2,,text,"",,,date_dmy,,,,"[g_uric2] = '1' or [g_uric2] = '0'",,RH,,,,
g_comments2,hospitalization_2,,notes,"General comments",,,,,,,,,RH,,,,
g_date3,hospitalization_3,,text,Date,,,date_dmy,,,,,,,,,,
g_fever3,hospitalization_3,"Symptoms at admission (outside of admission for delivery)",radio,Fever,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fever_temp3,hospitalization_3,,radio,"","1, < 38°C | 2, 38-39C | 3, > 39°C | 999, Unknown",,,,,,"[g_fever3] = '1'",,,,,,
g_cough3,hospitalization_3,,radio,Cough,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_head3,hospitalization_3,,radio,Headache,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_breath3,hospitalization_3,,radio,"Shortness of breath","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_runny3,hospitalization_3,,radio,"Runny nose","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_muscle3,hospitalization_3,,radio,"Muscle pain/myalgia","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anorexia3,hospitalization_3,,radio,"Anorexia (loss of appetite)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_diarrhea3,hospitalization_3,,radio,Diarrhea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_vomit3,hospitalization_3,,radio,Vomiting,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_malaise3,hospitalization_3,,radio,Malaise,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fatigue3,hospitalization_3,,radio,Fatigue,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anosmia3,hospitalization_3,,radio,"Anosmia or ageusia (loss of smell or taste)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_throat3,hospitalization_3,,radio,"Sore throat","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_sputum3,hospitalization_3,,radio,"Sputum production","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_nausea3,hospitalization_3,,radio,Nausea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_resp3,hospitalization_3,,radio,"Non-specific respiratory symptoms","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx3,hospitalization_3,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx_spec3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_othersx3] = '1'",,RH,,,,
g_othersx_23,hospitalization_3,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[g_othersx3] = '1'",,RH,,,,
g_othersx_spec_23,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_othersx_23] = '1'",,RH,,,,
g_icu3,hospitalization_3,,radio,"Admitted to ICU?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
g_icu_date3,hospitalization_3,,text,"ICU Admission Date",,,date_dmy,,,,"[g_icu3] = '1'",,,,,,
g_icu_dur3,hospitalization_3,,text,"Duration of Stay (days)",,"999 if unknown",number,,,,"[g_icu3] = '1'",,,,,,
g_hightemp3,hospitalization_3,,radio,"Highest patient temperature?","1, < 38°C | 2, 38-39°C | 3, >39°C | 999, Unknown",,,,,,,,,,,,
g_bpm3,hospitalization_3,,radio,"Maternal heart rate at admission (bpm)","1, < 100 bpm (NORMAL) | 2, 100-110 bpm | 3, 111-120 bpm | 4, >120 bpm | 999, Unknown",,,,,,,,,,,,
g_sysbp3,hospitalization_3,,text,"Maternal systolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_diabp3,hospitalization_3,,text,"Maternal diastolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_rr3,hospitalization_3,,radio,"Respiratory rate at admission (/min)","1, <22/min | 2, 22-34/min | 3, >34/min | 999, Unknown",,,,,,,,,,,,
g_oxysat3,hospitalization_3,,text,"Peripheral oxygen saturation at admission (SpO2%)",,"999 if unknown",number,,,,,,RH,,,,
g_alteredmental3,hospitalization_3,,radio,"Altered mental status","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg3,hospitalization_3,,radio,"ECG at admission","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg_result3,hospitalization_3,,radio,"","1, Normal | 0, Abnormal | 999, Unknown",,,,,,"[g_ecg3] = '1'",,RH,,,,
g_platelet3,hospitalization_3,,radio,"Platelet count - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_platelet_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_platelet3] = '0'",,RH,,,,
g_platelet_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_platelet3] = '0' or [g_platelet3] = '1'",,RH,,,,
g_wbc3,hospitalization_3,,radio,"White blood count (WBC) - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_wbc_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_wbc3] = '0'",,RH,,,,
g_wbc_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_wbc3] = '0' or [g_wbc3] = '1'",,RH,,,,
g_haem3,hospitalization_3,,radio,"Haemoglobin - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_haem_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_haem3] = '0'",,RH,,,,
g_haem_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_haem3] = '1' or [g_haem3] = '0'",,RH,,,,
g_crp3,hospitalization_3,,radio,"CRP - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_crp_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_crp3] = '0'",,RH,,,,
g_crp_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_crp3] = '1' or [g_crp3] = '0'",,RH,,,,
g_lactate3,hospitalization_3,,radio,"Lactate dehydrogenase (U/L >245) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_lactate_highlow3,hospitalization_3,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_lactate3] = '0'",,RH,,,,
g_lactate_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_lactate3] = '0'",,RH,,,,
g_lactate_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_lactate3] = '1' or [g_lactate3] = '0'",,RH,,,,
g_alt3,hospitalization_3,,radio,"ALT (U/L >40) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_alt_highlow3,hospitalization_3,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_alt3] = '0'",,RH,,,,
g_alt_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_alt3] = '0'",,RH,,,,
g_alt_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_alt3] = '1' or [g_alt3] = '0'",,RH,,,,
g_creat3,hospitalization_3,,radio,"Creatinine - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_creat_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_creat3] = '0'",,RH,,,,
g_creat_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_creat3] = '1' or [g_creat3] = '0'",,RH,,,,
g_uric3,hospitalization_3,,radio,"Uric acid - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_uric_value3,hospitalization_3,,text,"",,"999 if unknown",,,,,"[g_uric3] = '0'",,RH,,,,
g_uric_date3,hospitalization_3,,text,"",,,date_dmy,,,,"[g_uric3] = '1' or [g_uric3] = '0'",,RH,,,,
g_comments3,hospitalization_3,,notes,"General comments",,,,,,,,,RH,,,,
g_date4,hospitalization_4,,text,Date,,,date_dmy,,,,,,,,,,
g_fever4,hospitalization_4,"Symptoms at admission (outside of admission for delivery)",radio,Fever,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fever_temp4,hospitalization_4,,radio,"","1, < 38°C | 2, 38-39C | 3, > 39°C | 999, Unknown",,,,,,"[g_fever4] = '1'",,,,,,
g_cough4,hospitalization_4,,radio,Cough,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_head4,hospitalization_4,,radio,Headache,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_breath4,hospitalization_4,,radio,"Shortness of breath","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_runny4,hospitalization_4,,radio,"Runny nose","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_muscle4,hospitalization_4,,radio,"Muscle pain/myalgia","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anorexia4,hospitalization_4,,radio,"Anorexia (loss of appetite)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_diarrhea4,hospitalization_4,,radio,Diarrhea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_vomit4,hospitalization_4,,radio,Vomiting,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_malaise4,hospitalization_4,,radio,Malaise,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_fatigue4,hospitalization_4,,radio,Fatigue,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_anosmia4,hospitalization_4,,radio,"Anosmia or ageusia (loss of smell or taste)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_throat4,hospitalization_4,,radio,"Sore throat","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_sputum4,hospitalization_4,,radio,"Sputum production","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_nausea4,hospitalization_4,,radio,Nausea,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_resp4,hospitalization_4,,radio,"Non-specific respiratory symptoms","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx4,hospitalization_4,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_othersx_spec4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_othersx4] = '1'",,RH,,,,
g_othersx_24,hospitalization_4,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[g_othersx4] = '1'",,RH,,,,
g_othersx_spec_24,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_othersx_24] = '1'",,RH,,,,
g_icu4,hospitalization_4,,radio,"Admitted to ICU?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
g_icu_date4,hospitalization_4,,text,"ICU Admission Date",,,date_dmy,,,,"[g_icu4] = '1'",,,,,,
g_icu_dur4,hospitalization_4,,text,"Duration of Stay (days)",,"999 if unknown",number,,,,"[g_icu4] = '1'",,,,,,
g_hightemp4,hospitalization_4,,radio,"Highest patient temperature?","1, < 38°C | 2, 38-39°C | 3, >39°C | 999, Unknown",,,,,,,,,,,,
g_bpm4,hospitalization_4,,radio,"Maternal heart rate at admission (bpm)","1, < 100 bpm (NORMAL) | 2, 100-110 bpm | 3, 111-120 bpm | 4, >120 bpm | 999, Unknown",,,,,,,,,,,,
g_sysbp4,hospitalization_4,,text,"Maternal systolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_diabp4,hospitalization_4,,text,"Maternal diastolic blood pressure at admission (mmHg)",,"999 if unknown",number,,,,,,RH,,,,
g_rr4,hospitalization_4,,radio,"Respiratory rate at admission (/min)","1, <22/min | 2, 22-34/min | 3, >34/min | 999, Unknown",,,,,,,,,,,,
g_oxysat4,hospitalization_4,,text,"Peripheral oxygen saturation at admission (SpO2%)",,"999 if unknown",number,,,,,,RH,,,,
g_alteredmental4,hospitalization_4,,radio,"Altered mental status","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg4,hospitalization_4,,radio,"ECG at admission","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
g_ecg_result4,hospitalization_4,,radio,"","1, Normal | 0, Abnormal | 999, Unknown",,,,,,"[g_ecg4] = '1'",,RH,,,,
g_platelet4,hospitalization_4,,radio,"Platelet count - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_platelet_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_platelet4] = '0'",,RH,,,,
g_platelet_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_platelet4] = '0' or [g_platelet4] = '1'",,RH,,,,
g_wbc4,hospitalization_4,,radio,"White blood count (WBC) - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_wbc_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_wbc4] = '0'",,RH,,,,
g_wbc_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_wbc4] = '0' or [g_wbc4] = '1'",,RH,,,,
g_haem4,hospitalization_4,,radio,"Haemoglobin - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_haem_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_haem4] = '0'",,RH,,,,
g_haem_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_haem4] = '1' or [g_haem4] = '0'",,RH,,,,
g_crp4,hospitalization_4,,radio,"CRP - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_crp_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_crp4] = '0'",,RH,,,,
g_crp_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_crp4] = '1' or [g_crp4] = '0'",,RH,,,,
g_lactate4,hospitalization_4,,radio,"Lactate dehydrogenase (U/L >245) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_lactate_highlow4,hospitalization_4,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_lactate4] = '0'",,RH,,,,
g_lactate_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_lactate4] = '0'",,RH,,,,
g_lactate_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_lactate4] = '1' or [g_lactate4] = '0'",,RH,,,,
g_alt4,hospitalization_4,,radio,"ALT (U/L >40) - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_alt_highlow4,hospitalization_4,,radio,"","1, High? | 2, Low? | 999, Unknown",,,,,,"[g_alt4] = '0'",,RH,,,,
g_alt_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_alt4] = '0'",,RH,,,,
g_alt_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_alt4] = '1' or [g_alt4] = '0'",,RH,,,,
g_creat4,hospitalization_4,,radio,"Creatinine - within normal range?","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_creat_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_creat4] = '0'",,RH,,,,
g_creat_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_creat4] = '1' or [g_creat4] = '0'",,RH,,,,
g_uric4,hospitalization_4,,radio,"Uric acid - within normal range?
","1, Yes | 0, No | 999, Unknown | 2, No test",,,,,,,,RH,,,,
g_uric_value4,hospitalization_4,,text,"",,"999 if unknown",,,,,"[g_uric4] = '0'",,RH,,,,
g_uric_date4,hospitalization_4,,text,"",,,date_dmy,,,,"[g_uric4] = '1' or [g_uric4] = '0'",,RH,,,,
g_comments4,hospitalization_4,,notes,"General comments",,,,,,,,,RH,,,,
h_desc,pregnancy_history,,descriptive,"Please provide information on all prior pregnancies.
Note: T/a = Therapeutic abortion ; S/a= Spontaneous abortion
",,,,,,,,,,,,,
h_gravida,pregnancy_history,,text,Gravida,,"999 if unknown",number,,,,,,,,,,
h_term,pregnancy_history,,text,Term,,"999 if unknown",number,,,,"[h_gravida] > 1",,,,,,
h_preterm,pregnancy_history,,text,Preterm,,"999 if unknown",number,,,,"[h_gravida] > 1",,,,,,
h_abortion,pregnancy_history,,text,Abortion,,"999 if unknown",number,,,,"[h_gravida] > 1",,,,,,
h_abortion_ind,pregnancy_history,,text,"",,"999 if unknown",number,,,,"[h_abortion] > 0",,,,,,
h_abortion_spont,pregnancy_history,,text,"",,"999 if unknown",number,,,,"[h_abortion] > 0",,,,,,
h_living,pregnancy_history,,text,Living,,"999 if unknown",number,,,,"[h_gravida] > 1",,,,,,
h_year_1,pregnancy_history," ",text,"Year of birth / event",,"999 if unknown",number,,,,"[h_gravida] > 1",,,,,,
h_place_1,pregnancy_history,,text,"Place birth / abortion (city / country)",,"999 if unknown",,,,,"[h_gravida] > 1",,,,,,
h_ga_na_1,pregnancy_history,,checkbox,"Gestational age - N/A","1,",,,,,,"[h_gravida] > 1",,,,,,
h_ga_w_1,pregnancy_history,,text,"Gestational age - weeks",,"999 if unknown",number0-100,,,,"[h_gravida] > 1 and [h_ga_na_1(1)] = ''",,,,,,
h_ga_d_1,pregnancy_history,,text,"Gestational age - days",,"999 if unknown",number0-100,,,,"[h_gravida] > 1 and [h_ga_na_1(1)] = ''",,,,,,
h_type_1,pregnancy_history,,radio,"Type of birth","1, Vag | 2, C/s | 3, T/a | 4, S/a | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 1",,,,,,
h_complications_1,pregnancy_history,,checkbox,"Perinatal complications","1, Preeclampsia | 2, Intrauterine growth restriction | 3, Fetal malformation | 4, Preterm birth | 5, Postpartum hemorrhage | 998, Other | 999, Unknown | 0, None | 888, N/a",,,,,,"[h_gravida] > 1",,,,,,
h_complications_s_1,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_complications_1(998)] = '1'",,,,,,
h_children_1,pregnancy_history,,descriptive,"",,,,,,,"[h_gravida] > 1",,,,,,
h_sex_1,pregnancy_history,,text,Sex,,"999 if unknown",,,,,"[h_gravida] > 1",,,,,,
h_bweight_na_1,pregnancy_history,,checkbox,"Birth weight - N/A","1,",,,,,,"[h_gravida] > 1",,,,,,
h_bweight_1,pregnancy_history,,text,"Birth weight",,"999 if unknown",number,,,,"[h_gravida] > 1 and [h_bweight_na_1(1)] = ''",,,,,,
h_health_1,pregnancy_history,,radio,"Present health (alive and well/ demised/ significant health issue)","1, Alive / well | 2, Demised | 3, Significant health issue | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 1",,,,,,
h_health_desc_1,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_health_1] = '3'",,,,,,
h_year_2,pregnancy_history," ",text,"Year of birth / event",,"999 if unknown",number,,,,"[h_gravida] > 2",,,,,,
h_place_2,pregnancy_history,,text,"Place birth / abortion (city / country)",,"999 if unknown",,,,,"[h_gravida] > 2",,,,,,
h_ga_na_2,pregnancy_history,,checkbox,"Gestational age - N/A","1,",,,,,,"[h_gravida] > 2",,,,,,
h_ga_w_2,pregnancy_history,,text,"Gestational age - weeks",,"999 if unknown",number0-100,,,,"[h_gravida] > 2 and [h_ga_na_2(1)] = ''",,,,,,
h_ga_d_2,pregnancy_history,,text,"Gestational age - days",,"999 if unknown",number0-100,,,,"[h_gravida] > 2 and [h_ga_na_2(1)] = ''",,,,,,
h_type_2,pregnancy_history,,radio,"Type of birth","1, Vag | 2, C/s | 3, T/a | 4, S/a | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 2",,,,,,
h_complications_2,pregnancy_history,,checkbox,"Perinatal complications","1, Preeclampsia | 2, Intrauterine growth restriction | 3, Fetal malformation | 4, Preterm birth | 5, Postpartum hemorrhage | 998, Other | 999, Unknown | 0, None | 888, N/a",,,,,,"[h_gravida] > 2",,,,,,
h_complications_s_2,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_complications_2(998)] = '1'",,,,,,
h_children_2,pregnancy_history,,descriptive,"",,,,,,,"[h_gravida] > 2",,,,,,
h_sex_2,pregnancy_history,,text,Sex,,"999 if unknown",,,,,"[h_gravida] > 2",,,,,,
h_bweight_na_2,pregnancy_history,,checkbox,"Birth weight - N/A","1,",,,,,,"[h_gravida] > 2",,,,,,
h_bweight_2,pregnancy_history,,text,"Birth weight",,"999 if unknown",number,,,,"[h_gravida] > 2 and [h_bweight_na_2(1)] = ''",,,,,,
h_health_2,pregnancy_history,,radio,"Present health (alive and well/ demised/ significant health issue)","1, Alive / well | 2, Demised | 3, Significant health issue | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 2",,,,,,
h_health_desc_2,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_health_2] = '3'",,,,,,
h_year_3,pregnancy_history," ",text,"Year of birth / event",,"999 if unknown",number,,,,"[h_gravida] > 3",,,,,,
h_place_3,pregnancy_history,,text,"Place birth / abortion (city / country)",,"999 if unknown",,,,,"[h_gravida] > 3",,,,,,
h_ga_na_3,pregnancy_history,,checkbox,"Gestational age - N/A","1,",,,,,,"[h_gravida] > 3",,,,,,
h_ga_w_3,pregnancy_history,,text,"Gestational age - weeks",,"999 if unknown",number0-100,,,,"[h_gravida] > 3 and [h_ga_na_3(1)] = ''",,,,,,
h_ga_d_3,pregnancy_history,,text,"Gestational age - days",,"999 if unknown",number0-100,,,,"[h_gravida] > 3 and [h_ga_na_3(1)] = ''",,,,,,
h_type_3,pregnancy_history,,radio,"Type of birth","1, Vag | 2, C/s | 3, T/a | 4, S/a | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 3",,,,,,
h_complications_3,pregnancy_history,,checkbox,"Perinatal complications","1, Preeclampsia | 2, Intrauterine growth restriction | 3, Fetal malformation | 4, Preterm birth | 5, Postpartum hemorrhage | 998, Other | 999, Unknown | 0, None | 888, N/a",,,,,,"[h_gravida] > 3",,,,,,
h_complications_s_3,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_complications_3(998)] = '1'",,,,,,
h_children_3,pregnancy_history,,descriptive,"",,,,,,,"[h_gravida] > 3",,,,,,
h_sex_3,pregnancy_history,,text,Sex,,"999 if unknown",,,,,"[h_gravida] > 3",,,,,,
h_bweight_na_3,pregnancy_history,,checkbox,"Birth weight - N/A","1,",,,,,,"[h_gravida] > 3",,,,,,
h_bweight_3,pregnancy_history,,text,"Birth weight",,"999 if unknown",number,,,,"[h_gravida] > 3 and [h_bweight_na_3(1)] = ''",,,,,,
h_health_3,pregnancy_history,,radio,"Present health (alive and well/ demised/ significant health issue)","1, Alive / well | 2, Demised | 3, Significant health issue | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 3",,,,,,
h_health_desc_3,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_health_3] = '3'",,,,,,
h_year_4,pregnancy_history," ",text,"Year of birth / event",,"999 if unknown",number,,,,"[h_gravida] > 4",,,,,,
h_place_4,pregnancy_history,,text,"Place birth / abortion (city / country)",,"999 if unknown",,,,,"[h_gravida] > 4",,,,,,
h_ga_na_4,pregnancy_history,,checkbox,"Gestational age - N/A","1,",,,,,,"[h_gravida] > 4",,,,,,
h_ga_w_4,pregnancy_history,,text,"Gestational age - weeks",,"999 if unknown",number0-100,,,,"[h_gravida] > 4 and [h_ga_na_4(1)] = ''",,,,,,
h_ga_d_4,pregnancy_history,,text,"Gestational age - days",,"999 if unknown",number0-100,,,,"[h_gravida] > 4 and [h_ga_na_4(1)] = ''",,,,,,
h_type_4,pregnancy_history,,radio,"Type of birth","1, Vag | 2, C/s | 3, T/a | 4, S/a | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 4",,,,,,
h_complications_4,pregnancy_history,,checkbox,"Perinatal complications","1, Preeclampsia | 2, Intrauterine growth restriction | 3, Fetal malformation | 4, Preterm birth | 5, Postpartum hemorrhage | 998, Other | 999, Unknown | 0, None | 888, N/a",,,,,,"[h_gravida] > 4",,,,,,
h_complications_s_4,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_complications_4(998)] = '1'",,,,,,
h_children_4,pregnancy_history,,descriptive,"",,,,,,,"[h_gravida] > 4",,,,,,
h_sex_4,pregnancy_history,,text,Sex,,"999 if unknown",,,,,"[h_gravida] > 4",,,,,,
h_bweight_na_4,pregnancy_history,,checkbox,"Birth weight - N/A","1,",,,,,,"[h_gravida] > 4",,,,,,
h_bweight_4,pregnancy_history,,text,"Birth weight",,"999 if unknown",,,,,"[h_gravida] > 4 and [h_bweight_na_4(1)] = ''",,,,,,
h_health_4,pregnancy_history,,radio,"Present health (alive and well/ demised/ significant health issue)","1, Alive / well | 2, Demised | 3, Significant health issue | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 4",,,,,,
h_health_desc_4,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_health_4] = '3'",,,,,,
h_year_5,pregnancy_history," ",text,"Year of birth / event",,"999 if unknown",number,,,,"[h_gravida] > 5",,,,,,
h_place_5,pregnancy_history,,text,"Place birth / abortion (city / country)",,"999 if unknown",,,,,"[h_gravida] > 5",,,,,,
h_ga_na_5,pregnancy_history,,checkbox,"Gestational age - N/A","1,",,,,,,"[h_gravida] > 5",,,,,,
h_ga_w_5,pregnancy_history,,text,"Gestational age - weeks",,"999 if unknown",number0-100,,,,"[h_gravida] > 5 and [h_ga_na_5(1)] = ''",,,,,,
h_ga_d_5,pregnancy_history,,text,"Gestational age - days",,"999 if unknown",number0-100,,,,"[h_gravida] > 5 and [h_ga_na_5(1)] = ''",,,,,,
h_type_5,pregnancy_history,,radio,"Type of birth","1, Vag | 2, C/s | 3, T/a | 4, S/a | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 5",,,,,,
h_complications_5,pregnancy_history,,checkbox,"Perinatal complications","1, Preeclampsia | 2, Intrauterine growth restriction | 3, Fetal malformation | 4, Preterm birth | 5, Postpartum hemorrhage | 998, Other | 999, Unknown | 0, None | 888, N/a",,,,,,"[h_gravida] > 5",,,,,,
h_complications_s_5,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_complications_5(998)] = '1'",,,,,,
h_children_5,pregnancy_history,,descriptive,"",,,,,,,"[h_gravida] > 5",,,,,,
h_sex_5,pregnancy_history,,text,Sex,,"999 if unknown",,,,,"[h_gravida] > 5",,,,,,
h_bweight_na_5,pregnancy_history,,checkbox,"Birth weight - N/A","1,",,,,,,"[h_gravida] > 5",,,,,,
h_bweight_5,pregnancy_history,,text,"Birth weight",,"999 if unknown",number,,,,"[h_gravida] > 5 and [h_bweight_na_5(1)] = ''",,,,,,
h_health_5,pregnancy_history,,radio,"Present health (alive and well/ demised/ significant health issue)","1, Alive / well | 2, Demised | 3, Significant health issue | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 5",,,,,,
h_health_desc_5,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_health_5] = '3'",,,,,,
h_year_6,pregnancy_history," ",text,"Year of birth / event",,"999 if unknown",number,,,,"[h_gravida] > 6",,,,,,
h_place_6,pregnancy_history,,text,"Place birth / abortion (city / country)",,"999 if unknown",,,,,"[h_gravida] > 6",,,,,,
h_ga_na_6,pregnancy_history,,checkbox,"Gestational age - N/A","1,",,,,,,"[h_gravida] > 6",,,,,,
h_ga_w_6,pregnancy_history,,text,"Gestational age - weeks",,"999 if unknown",number0-100,,,,"[h_gravida] > 6 and [h_ga_na_6(1)] = ''",,,,,,
h_ga_d_6,pregnancy_history,,text,"Gestational age - days",,"999 if unknown",number0-100,,,,"[h_gravida] > 6 and [h_ga_na_6(1)] = ''",,,,,,
h_type_6,pregnancy_history,,radio,"Type of birth","1, Vag | 2, C/s | 3, T/a | 4, S/a | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 6",,,,,,
h_complications_6,pregnancy_history,,checkbox,"Perinatal complications","1, Preeclampsia | 2, Intrauterine growth restriction | 3, Fetal malformation | 4, Preterm birth | 5, Postpartum hemorrhage | 998, Other | 999, Unknown | 0, None | 888, N/a",,,,,,"[h_gravida] > 6",,,,,,
h_complications_s_6,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_complications_6(998)] = '1'",,,,,,
h_children_6,pregnancy_history,,descriptive,"",,,,,,,"[h_gravida] > 6",,,,,,
h_sex_6,pregnancy_history,,text,Sex,,"999 if unknown",,,,,"[h_gravida] > 6",,,,,,
h_bweight_na_6,pregnancy_history,,checkbox,"Birth weight - N/A","1,",,,,,,"[h_gravida] > 6",,,,,,
h_bweight_6,pregnancy_history,,text,"Birth weight",,"999 if unknown",number,,,,"[h_gravida] > 6 and [h_bweight_na_6(1)] = ''",,,,,,
h_health_6,pregnancy_history,,radio,"Present health (alive and well/ demised/ significant health issue)","1, Alive / well | 2, Demised | 3, Significant health issue | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 6",,,,,,
h_health_desc_6,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_health_6] = '3'",,,,,,
h_year_7,pregnancy_history," ",text,"Year of birth / event",,"999 if unknown",number,,,,"[h_gravida] > 7",,,,,,
h_place_7,pregnancy_history,,text,"Place birth / abortion (city / country)",,"999 if unknown",,,,,"[h_gravida] > 7",,,,,,
h_ga_na_7,pregnancy_history,,checkbox,"Gestational age - N/A","1,",,,,,,"[h_gravida] > 7",,,,,,
h_ga_w_7,pregnancy_history,,text,"Gestational age - weeks",,"999 if unknown",number0-100,,,,"[h_gravida] > 7 and [h_ga_na_7(1)] = ''",,,,,,
h_ga_d_7,pregnancy_history,,text,"Gestational age - days",,"999 if unknown",number0-100,,,,"[h_gravida] > 7 and [h_ga_na_7(1)] = ''",,,,,,
h_type_7,pregnancy_history,,radio,"Type of birth","1, Vag | 2, C/s | 3, T/a | 4, S/a | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 7",,,,,,
h_complications_7,pregnancy_history,,checkbox,"Perinatal complications","1, Preeclampsia | 2, Intrauterine growth restriction | 3, Fetal malformation | 4, Preterm birth | 5, Postpartum hemorrhage | 998, Other | 999, Unknown | 0, None | 888, N/a",,,,,,"[h_gravida] > 7",,,,,,
h_complications_s_7,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_complications_7(998)] = '1'",,,,,,
h_children_7,pregnancy_history,,descriptive,"",,,,,,,"[h_gravida] > 7",,,,,,
h_sex_7,pregnancy_history,,text,Sex,,"999 if unknown",,,,,"[h_gravida] > 7",,,,,,
h_bweight_na_7,pregnancy_history,,checkbox,"Birth weight - N/A","1,",,,,,,"[h_gravida] > 7",,,,,,
h_bweight_7,pregnancy_history,,text,"Birth weight",,"999 if unknown",number,,,,"[h_gravida] > 7 and [h_bweight_na_7(1)] = ''",,,,,,
h_health_7,pregnancy_history,,radio,"Present health (alive and well/ demised/ significant health issue)","1, Alive / well | 2, Demised | 3, Significant health issue | 999, Unknown | 888, N/a",,,,,,"[h_gravida] > 7",,,,,,
h_health_desc_7,pregnancy_history,,notes,"",,"999 if unknown",,,,,"[h_health_7] = '3'",,,,,,
h_comments,pregnancy_history," ",notes,"General comments",,,,,,,,,,,,,
i_lmp,pregnancy_information,,text,"Calculated LMP",,,date_dmy,,,,,,,,,,
i_deliverydate_est,pregnancy_information,,text,"Confirmed estimated date of delivery ",,,date_dmy,,,,,,,,,,
i_deliverydate_method,pregnancy_information,,radio,"Based on (best available method)
","1, Last menstrual period | 2, First trimester ultrasound with an embryo >= 10mm | 3, Ultrasound (if second trimester +) | 999, Unknown",,,,,,"[i_deliverydate_est] <> ''",,,,,,
i_ivf,pregnancy_information,,radio,"IVF pregnancy?","0, No | 1, Yes | 999, Unknown",,,,,,,,,,,,
i_ivf_specify,pregnancy_information,,text,"",,"999 if unknown",,,,,"[i_ivf] = '1'",,,,,,
i_alcohol,pregnancy_information,,radio,"Alcohol use in pregnancy","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
i_bingedrinking,pregnancy_information,,radio,"Binge drinking in pregnancy
","0, No | 1, Yes | 999, Unknown",,,,,,"[i_alcohol] = '1'",,RH,,,,
i_substance,pregnancy_information,,radio,"Substance use in pregnancy (outside of medications prescribed to patient)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
i_substance_specify,pregnancy_information,,checkbox,"","1, Heroin | 2, Cocaine | 3, Marijuana | 5, Solvents | 998, Other | 999, Unknown",,,,,,"[i_substance] = '1'",,,,,,
i_substance_other,pregnancy_information,,text,"",,"999 if unknown",,,,,"[i_substance_specify(998)] = '1'",,,,,,
i_smokingb,pregnancy_information,,radio,"Smoking before pregnancy","1, Yes | 0, Never | 2, Quit | 999, Unknown",,,,,,,,RH,,,,
i_smoking_quit,pregnancy_information,,text,"",,,date_dmy,,,,"[i_smokingb] = '2'",,,,,,
i_smoking_before_d,pregnancy_information,,text,"Average # cigarettes / day
",,,number,,,,"([i_smokingb] = '1' or [i_smokingb] = '2') and [i_smoking_before_w] = '' and [i_smoking_before_unk(1)] = ''",,,,,,
i_smoking_before_w,pregnancy_information,,text,"Average # cigarettes / week
",,,number,,,,"([i_smokingb] = '1' or [i_smokingb] = '2') and [i_smoking_before_d] = '' and [i_smoking_before_unk(1)] = ''",,,,,,
i_smoking_before_unk,pregnancy_information,,checkbox,"Average # cigarettes unknown
","1,",,,,,,"([i_smokingb] = '1' or [i_smokingb] = '2') and [i_smoking_before_w] = '' and [i_smoking_before_d] = ''",,,,,,
i_smokingd,pregnancy_information,,radio,"Smoking during pregnancy","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
i_smoking_during_d,pregnancy_information,,text,"Average # cigarettes / day
",,,number,,,,"[i_smokingd] = '1' and [i_smoking_during_w] = '' and [i_smoking_during_unk(1)] = '0'",,,,,,
i_smoking_during_w,pregnancy_information,,text,"Average # cigarettes / week
",,,number,,,,"[i_smokingd] = '1' and [i_smoking_during_d] = '' and [i_smoking_during_unk(1)] = '0'",,,,,,
i_smoking_during_unk,pregnancy_information,,checkbox,"Average # cigarettes unknown
","1,",,,,,,"[i_smokingd] = '1' and [i_smoking_during_w] = '' and [i_smoking_during_d] = ''",,,,,,
i_2ndhandsmoke,pregnancy_information,,radio,"Exposure 2nd hand smoke during pregnancy ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
i_height,pregnancy_information,,text,"Height (cm)",,"999 if unknown",number,,,,,,,,,,
i_weight,pregnancy_information,,text,"Weight pre / early pregnancy in kg (weight right before pregnancy or earliest recorded in pregnancy)",,"999 if unknown",number,,,,,,,,,,
i_fetusnumber,pregnancy_information,,radio,"# fetuses","1, 1 | 2, 2 | 3, 3 | 4, >= 4 | 999, Unknown",,,,,,,,LH,,,,
i_fetusnumber_specify,pregnancy_information,,text,"",,"999 if unknown",number,,,,"[i_fetusnumber] = '4'",,,,,,
i_fetus_multiples,pregnancy_information,,radio,"","1, Twin: Dichorionic Diamniotic | 2, Twin: Monochorionic Diamniotic | 3, Twin: Monochorionic Monoamniotic | 4, Triplets | 998, Other | 999, Unknown",,,,,,,,,,,,
i_fetus_triplets_s,pregnancy_information,,text,"",,,,,,,"[i_fetus_multiples] = '4'",,,,,,
i_fetus_multiples_s,pregnancy_information,,text,"",,,,,,,"[i_fetus_multiples] = '998'",,,,,,
i_comments,pregnancy_information," ",notes,"General comments",,,,,,,,,,,,,
j_desc,comorbidities_in_pregnancy,,descriptive,"Please report maternal health comorbidities in pregnancy",,,,,,,,,,,,,
j_none,comorbidities_in_pregnancy,,checkbox,"No comorbidities, skip to pregnancy screening","1,",,,,,,,,,,,,
j_desc2,comorbidities_in_pregnancy,,descriptive,"NOTE: Record all medications on COVID medications / General medications forms
",,,,,,,,,,,,,
j_desc3,comorbidities_in_pregnancy,,descriptive,"Check all that apply",,,,,,,"[j_none(1)] <> '1'",,,,,,
j_cns,comorbidities_in_pregnancy,,radio,"CNS - Central Nervous System","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_cns_head,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cns] = '1'",,,,,,
j_cns_head_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cns_head(1)] = '1'",,RH,,,,
j_cns_head_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cns_head_med] = '1'",,,,,,
j_cns_mig,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cns] = '1'",,,,,,
j_cns_mig_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cns_mig(1)] = '1'",,RH,,,,
j_cns_mig_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cns_mig_med] = '1'",,,,,,
j_cns_epil,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cns] = '1'",,,,,,
j_cns_epil_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cns_epil(1)] = '1'",,RH,,,,
j_cns_epil_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cns_epil_med] = '1'",,,,,,
j_cns_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cns] = '1'",,,,,,
j_cns_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_cns_oth(1)] = '1'",,,,,,
j_cns_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cns_oth(1)] = '1'",,RH,,,,
j_cns_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cns_oth_med] = '1'",,,,,,
j_eentm,comorbidities_in_pregnancy,,radio,"EENT+M - Ears, Eyes, Nose Throat & Mouth","1, Yes | 0, No | 999, Unknown","Allergies go in ""Allergies/immune"" below",,,,,"[j_none(1)] <> '1'",,RH,,,,
j_eentm_s1,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_eentm] = '1'",,,,,,
j_eentm_s1_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_eentm] = '1'",,RH,,,,
j_eentm_s1_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,,,,,,"[j_eentm_s1_med] = '1'",,,,,,
j_eentm_s2,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_eentm_s1] <> ''",,,,,,
j_eentm_s2_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_eentm_s2] <> ''",,RH,,,,
j_eentm_s2_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_eentm_s2_med] = '1'",,,,,,
j_cvs,comorbidities_in_pregnancy,,radio,"CVS - Cardiovascular","1, Yes | 0, No | 999, Unknown","If gest hypertension, document under complications related to pregnancy",,,,,"[j_none(1)] <> '1'",,RH,,,,
j_cvs_htn,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cvs] = '1'",,,,,,
j_cvs_htn_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cvs_htn(1)] = '1'",,RH,,,,
j_cvs_htn_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cvs_htn_med] = '1'",,,,,,
j_cvs_arr,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cvs] = '1'",,,,,,
j_cvs_arr_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_cvs_arr(1)] = '1'",,,,,,
j_cvs_arr_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cvs_arr(1)] = '1'",,RH,,,,
j_cvs_arr_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cvs_arr_med] = '1'",,,,,,
j_cvs_valve,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cvs] = '1'",,,,,,
j_cvs_valve_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cvs_valve(1)] = '1'",,RH,,,,
j_cvs_valve_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cvs_valve_med] = '1'",,,,,,
j_cvs_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_cvs] = '1'",,,,,,
j_cvs_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_cvs_oth(1)] = '1'",,,,,,
j_cvs_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_cvs_oth(1)] = '1'",,RH,,,,
j_cvs_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_cvs_oth_med] = '1'",,,,,,
j_resp,comorbidities_in_pregnancy,,radio,"RESP - Respiratory ","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_resp_asth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_resp] = '1'",,,,,,
j_resp_asth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_resp_asth(1)] = '1'",,RH,,,,
j_resp_asth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_resp_asth_med] = '1'",,,,,,
j_resp_lung,comorbidities_in_pregnancy,,checkbox,"Chronic obstructive lung disease
","1,",,,,,,"[j_resp] = '1'",,,,,,
j_resp_lung_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_resp_lung(1)] = '1'",,RH,,,,
j_resp_lung_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_resp_lung_med] = '1'",,,,,,
j_resp_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_resp] = '1'",,,,,,
j_resp_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_resp_oth(1)] = '1'",,,,,,
j_resp_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_resp_oth(1)] = '1'",,RH,,,,
j_resp_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_resp_oth_med] = '1'",,,,,,
j_gi,comorbidities_in_pregnancy,,radio,"GI - Gastrointestinal ","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_gi_ibd,comorbidities_in_pregnancy,,checkbox,"Irritable bowel disease (IBD)
","1,",,,,,,"[j_gi] = '1'",,,,,,
j_gi_ibd_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_gi_ibd(1)] = '1'",,RH,,,,
j_gi_ibd_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_gi_ibd_med] = '1'",,,,,,
j_gi_celiac,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_gi] = '1'",,,,,,
j_gi_celiac_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_gi_celiac(1)] = '1'",,RH,,,,
j_gi_celiac_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_gi_celiac_med] = '1'",,,,,,
j_gi_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_gi] = '1'",,,,,,
j_gi_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_gi_oth(1)] = '1'",,,,,,
j_gi_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_gi_oth(1)] = '1'",,RH,,,,
j_gi_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_gi_oth_med] = '1'",,,,,,
j_gu,comorbidities_in_pregnancy,,radio,"GU - Genitourinary","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_gu_uti,comorbidities_in_pregnancy,,checkbox,"Recurrent urinary tract infection (UTI)
","1,",,,,,,"[j_gu] = '1'",,,,,,
j_gu_utj_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_gu_uti(1)] = '1'",,RH,,,,
j_gu_utj_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_gu_utj_med] = '1'",,,,,,
j_gu_oth1,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_gu] = '1'",,,,,,
j_gu_oth1_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_gu_oth1(1)] = '1'",,RH,,,,
j_gu_oth1_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_gu_oth1(1)] = '1'",,RH,,,,
j_gu_oth1_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_gu_oth1_med] = '1'",,,,,,
j_gu_oth2,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_gu] = '1' and [j_gu_oth1(1)] = '1'",,,,,,
j_gu_oth2_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_gu_oth2(1)] = '1'",,RH,,,,
j_gu_oth2_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_gu_oth2(1)] = '1'",,RH,,,,
j_gu_oth2_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_gu_oth2_med] = '1'",,,,,,
j_repro,comorbidities_in_pregnancy,,radio,"REPRO - Reproductive","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_repro_cervhx,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_repro] = '1'",,,,,,
j_repro_cervhx_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_repro_cervhx(1)] = '1'",,RH,,,,
j_repro_cervhx_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_repro_cervhx_med] = '1'",,,,,,
j_repro_cervcur,comorbidities_in_pregnancy,,checkbox,"Short cervix current preg
","1,",,,,,,"[j_repro] = '1'",,,,,,
j_repro_cervcur_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_repro_cervcur(1)] = '1'",,RH,,,,
j_repro_cervcur_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_repro_cervcur_med] = '1'",,,,,,
j_repro_oth1,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_repro] = '1'",,,,,,
j_repro_oth1_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_repro_oth1(1)] = '1'",,,,,,
j_repro_oth1_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_repro_oth1(1)] = '1'",,RH,,,,
j_repro_oth1_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_repro_oth1_med] = '1'",,,,,,
j_repro_oth2,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_repro] = '1' and [j_repro_oth1(1)] = '1'",,,,,,
j_repro_oth2_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_repro_oth2(1)] = '1'",,,,,,
j_repro_oth2_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_repro_oth2(1)] = '1'",,RH,,,,
j_repro_oth2_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_repro_oth2_med] = '1'",,,,,,
j_endo,comorbidities_in_pregnancy,,radio,"ENDO - Endocrine","1, Yes | 0, No | 999, Unknown","If gest diabetes, document under complications related to pregnancy",,,,,"[j_none(1)] <> '1'",,RH,,,,
j_endo_thy,comorbidities_in_pregnancy,,checkbox,"Thyroid function imbalances
","1,",,,,,,"[j_endo] = '1'",,,,,,
j_endo_thy_s,comorbidities_in_pregnancy,,checkbox,"","1, Hypothyroidism | 2, Hyperthyroidism | 998, Other | 999, Unknown",,,,,,"[j_endo_thy(1)] = '1'",,,,,,
j_endo_thy_s_oth,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_endo_thy_s(998)] = '1'",,,,,,
j_endo_thy_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_endo_thy(1)] = '1'",,RH,,,,
j_endo_thy_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_endo_thy_med] = '1'",,,,,,
j_endo_diabt1,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_endo] = '1'",,,,,,
j_endo_diabt1_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_endo_diabt1(1)] = '1'",,RH,,,,
j_endo_diabt1_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_endo_diabt1_med] = '1'",,,,,,
j_endo_diabt2,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_endo] = '1'",,,,,,
j_endo_diabt2_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_endo_diabt2(1)] = '1'",,RH,,,,
j_endo_diabt2_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_endo_diabt2_med] = '1'",,,,,,
j_endo_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_endo] = '1'",,,,,,
j_endo_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_endo_oth(1)] = '1'",,,,,,
j_endo_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_endo_oth(1)] = '1'",,RH,,,,
j_endo_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_endo_oth_med] = '1'",,,,,,
j_ms,comorbidities_in_pregnancy,,radio,"MS - Musculoskeletal","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_ms_ra,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_ms] = '1'",,,,,,
j_ms_ra_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_ms_ra(1)] = '1'",,RH,,,,
j_ms_ra_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_ms_ra_med] = '1'",,,,,,
j_ms_as,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_ms] = '1'",,,,,,
j_ms_as_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_ms_as(1)] = '1'",,RH,,,,
j_ms_as_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_ms_as_med] = '1'",,,,,,
j_ms_lupus,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_ms] = '1'",,,,,,
j_ms_lupus_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_ms_lupus(1)] = '1'",,,,,,
j_ms_lupus_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_ms_lupus(1)] = '1'",,RH,,,,
j_ms_lupus_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_ms_lupus_med] = '1'",,,,,,
j_ms_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_ms] = '1'",,,,,,
j_ms_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_ms_oth(1)] = '1'",,,,,,
j_ms_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_ms_oth(1)] = '1'",,RH,,,,
j_ms_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_ms_oth_med] = '1'",,,,,,
j_hem,comorbidities_in_pregnancy,,radio,"HEM - Hematologic","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_hem_throm,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_hem] = '1'",,,,,,
j_hem_throm_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_hem_throm(1)] = '1'",,RH,,,,
j_hem_throm_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_hem_throm_med] = '1'",,,,,,
j_hem_dvt,comorbidities_in_pregnancy,,checkbox,"Deep veion thrombosis (DVT)
","1,",,,,,,"[j_hem] = '1'",,,,,,
j_hem_dvt_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_hem_dvt(1)] = '1'",,RH,,,,
j_hem_dvt_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_hem_dvt_med] = '1'",,,,,,
j_hem_itp,comorbidities_in_pregnancy,,checkbox,"Immune thrombocytopenic purpura (ITP)
","1,",,,,,,"[j_hem] = '1'",,,,,,
j_hem_itp_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_hem_itp(1)] = '1'",,RH,,,,
j_hem_itp_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_hem_itp_med] = '1'",,,,,,
j_hem_anem,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_hem] = '1'",,,,,,
j_hem_anem_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_hem_anem(1)] = '1'",,RH,,,,
j_hem_anem_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_hem_anem_med] = '1'",,,,,,
j_hem_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_hem] = '1'",,,,,,
j_hem_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_hem_oth(1)] = '1'",,,,,,
j_hem_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_hem_oth(1)] = '1'",,RH,,,,
j_hem_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_hem_oth_med] = '1'",,,,,,
j_mh,comorbidities_in_pregnancy,,radio,"MH - Mental Health","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_mh_dep,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_mh] = '1'",,,,,,
j_mh_dep_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_mh_dep(1)] = '1'",,RH,,,,
j_mh_dep_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_mh_dep_med] = '1'",,,,,,
j_mh_anx,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_mh] = '1'",,,,,,
j_mh_anx_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_mh_anx(1)] = '1'",,RH,,,,
j_mh_anx_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_mh_anx_med] = '1'",,,,,,
j_mh_schiz,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_mh] = '1'",,,,,,
j_mh_schiz_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_mh_schiz(1)] = '1'",,RH,,,,
j_mh_schiz_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_mh_schiz_med] = '1'",,,,,,
j_mh_bipolar,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_mh] = '1'",,,,,,
j_mh_bipolar_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_mh_bipolar(1)] = '1'",,RH,,,,
j_mh_bipolar_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_mh_bipolar_med] = '1'",,,,,,
j_mh_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_mh] = '1'",,,,,,
j_mh_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_mh_oth(1)] = '1'",,,,,,
j_mh_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_mh_oth(1)] = '1'",,RH,,,,
j_mh_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_mh_oth_med] = '1'",,,,,,
j_aai,comorbidities_in_pregnancy,,radio,"AAI - Allergies / Autoimmune Disorders
","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_aai_drug,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_aai] = '1'",,,,,,
j_aai_drug_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_aai_drug(1)] = '1'",,,,,,
j_aai_drug_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_aai_drug(1)] = '1'",,RH,,,,
j_aai_drug_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_aai_drug_med] = '1'",,,,,,
j_aai_env,comorbidities_in_pregnancy,,checkbox,"Allergies, environmental / food
","1,",,,,,,"[j_aai] = '1'",,,,,,
j_aai_env_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_aai_env(1)] = '1'",,,,,,
j_aai_env_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_aai_env(1)] = '1'",,RH,,,,
j_aai_env_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_aai_env_med] = '1'",,,,,,
j_aai_oth,comorbidities_in_pregnancy,,checkbox,"","1,",,,,,,"[j_aai] = '1'",,,,,,
j_aai_oth_s,comorbidities_in_pregnancy,,text,"",,"999 if unknown",,,,,"[j_aai_oth(1)] = '1'",,,,,,
j_aai_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_aai_oth(1)] = '1'",,RH,,,,
j_aai_env_oth_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_aai_oth_med] = '1'",,,,,,
j_oth,comorbidities_in_pregnancy,,radio,"Other 1","1, Yes | 0, No | 999, Unknown",,,,,,"[j_none(1)] <> '1'",,RH,,,,
j_oth_system,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth] = '1'",,,,,,
j_oth_diag,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth] = '1'",,,,,,
j_oth_med,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth] = '1'",,RH,,,,
j_oth_med_s,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med] = '1'",,,,,,
j_oth_2,comorbidities_in_pregnancy,,radio,"Other 2
","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth] = '1'",,RH,,,,
j_oth_system_2,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_2] = '1'",,,,,,
j_oth_diag_2,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_2] = '1'",,,,,,
j_oth_med_2,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_2] = '1'",,RH,,,,
j_oth_med_s_2,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_2] = '1'",,,,,,
j_oth_3,comorbidities_in_pregnancy,,radio,"Other 3
","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_2] = '1'",,RH,,,,
j_oth_system_3,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_3] = '1'",,,,,,
j_oth_diag_3,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_3] = '1'",,,,,,
j_oth_med_3,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_3] = '1'",,RH,,,,
j_oth_med_s_3,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_3] = '1'",,,,,,
j_oth_4,comorbidities_in_pregnancy,,radio,"Other 4
","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_3] = '1'",,RH,,,,
j_oth_system_4,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_4] = '1'",,,,,,
j_oth_diag_4,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_4] = '1'",,,,,,
j_oth_med_4,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_4] = '1'",,RH,,,,
j_oth_med_s_4,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_4] = '1'",,,,,,
j_oth_5,comorbidities_in_pregnancy,,radio,"Other 5","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_4] = '1'",,RH,,,,
j_oth_system_5,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_5] = '1'",,,,,,
j_oth_diag_5,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_5] = '1'",,,,,,
j_oth_med_5,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_5] = '1'",,RH,,,,
j_oth_med_s_5,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_5] = '1'",,,,,,
j_oth_6,comorbidities_in_pregnancy,,radio,"Other 6","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_5] = '1'",,RH,,,,
j_oth_system_6,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_6] = '1'",,,,,,
j_oth_diag_6,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_6] = '1'",,,,,,
j_oth_med_6,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_6] = '1'",,RH,,,,
j_oth_med_s_6,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_6] = '1'",,,,,,
j_oth_7,comorbidities_in_pregnancy,,radio,"Other 7","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_6] = '1'",,RH,,,,
j_oth_system_7,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_7] = '1'",,,,,,
j_oth_diag_7,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_7] = '1'",,,,,,
j_oth_med_7,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_7] = '1'",,RH,,,,
j_oth_med_s_7,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_7] = '1'",,,,,,
j_oth_8,comorbidities_in_pregnancy,,radio,"Other 8","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_7] = '1'",,RH,,,,
j_oth_system_8,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_8] = '1'",,,,,,
j_oth_diag_8,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_8] = '1'",,,,,,
j_oth_med_8,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_8] = '1'",,RH,,,,
j_oth_med_s_8,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_8] = '1'",,,,,,
j_oth_9,comorbidities_in_pregnancy,,radio,"Other 9","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_8] = '1'",,RH,,,,
j_oth_system_9,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_9] = '1'",,,,,,
j_oth_diag_9,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_9] = '1'",,,,,,
j_oth_med_9,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_9] = '1'",,RH,,,,
j_oth_med_s_9,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_9] = '1'",,,,,,
j_oth_10,comorbidities_in_pregnancy,,radio,"Other 10","1, Yes | 0, No | 999, Unknown",,,,,,"[j_oth_9] = '1'",,RH,,,,
j_oth_system_10,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_10] = '1'",,,,,,
j_oth_diag_10,comorbidities_in_pregnancy,,text,"",,,,,,,"[j_oth_10] = '1'",,,,,,
j_oth_med_10,comorbidities_in_pregnancy,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[j_oth_10] = '1'",,RH,,,,
j_oth_med_s_10,comorbidities_in_pregnancy,,descriptive,"Indicate in General Meds Form
",,"999 if unknown",,,,,"[j_oth_med_10] = '1'",,,,,,
j_comments,comorbidities_in_pregnancy," ",notes,"General comments",,,,,,,,,,,,,
k_nipt,pregnancy_screening,"Aneuploidy screening",descriptive,NIPT,,,,,,,,,,,,,
k_nipt_na,pregnancy_screening,,radio,"","999, Unknown | 888, Not done",,,,,,,,LH,,,,
k_nipt_date,pregnancy_screening,,text,"",,,date_dmy,,,,"[k_nipt_na] = ''",,,,,,
k_nipt_result,pregnancy_screening,,radio,"","0, Neg/norm | 1, Pos | 999, Unk",,,,,,"[k_nipt_na] = ''",,RH,,,,
k_nipt_comments,pregnancy_screening,,text,"",,,,,,,"[k_nipt_na] = ''",,,,,,
k_serum,pregnancy_screening,,descriptive,"Serum screening",,,,,,,,,,,,,
k_serum_na,pregnancy_screening,,radio,"","999, Unknown | 888, Not done",,,,,,,,LH,,,,
k_serum_date,pregnancy_screening,,text,"",,,date_dmy,,,,"[k_serum_na] = ''",,,,,,
k_serum_result,pregnancy_screening,,radio,"","0, Neg/norm | 1, Pos | 999, Unk",,,,,,"[k_serum_na] = ''",,RH,,,,
k_serum_comments,pregnancy_screening,,text,"",,,,,,,"[k_serum_na] = ''",,,,,,
k_amnio,pregnancy_screening,,descriptive,Amniocentesis,,,,,,,,,,,,,
k_amnio_na,pregnancy_screening,,radio,"","999, Unknown | 888, Not done",,,,,,,,LH,,,,
k_amnio_date,pregnancy_screening,,text,"",,,date_dmy,,,,"[k_amnio_na] = ''",,,,,,
k_amnio_result,pregnancy_screening,,radio,"","0, Neg/norm | 1, Pos | 999, Unk",,,,,,"[k_amnio_na] = ''",,RH,,,,
k_amnio_comments,pregnancy_screening,,text,"",,,,,,,"[k_amnio_na] = ''",,,,,,
k_aneu_other,pregnancy_screening,,descriptive,Other,,,,,,,,,,,,,
k_aneu_other_na,pregnancy_screening,,radio,"","999, Unknown | 888, Not done",,,,,,,,LH,,,,
k_aneu_other_s,pregnancy_screening,,text,"",,,,,,,"[k_aneu_other_na] = ''",,RH,,,,
k_aneu_other_date,pregnancy_screening,,text,"",,,date_dmy,,,,"[k_aneu_other_na] = ''",,RH,,,,
k_aneu_other_result,pregnancy_screening,,radio,"","0, Neg/norm | 1, Pos | 999, Unk",,,,,,"[k_aneu_other_na] = ''",,RH,,,,
k_aneu_other_comments,pregnancy_screening,,text,"",,,,,,,"[k_aneu_other_na] = ''",,RH,,,,
k_hiv,pregnancy_screening,"Infectious serotesting",radio,HIV,"0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_hbv,pregnancy_screening,,radio,"HBV sAg","0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_hcv,pregnancy_screening,,radio,HCV,"0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_gbs,pregnancy_screening,,radio,GBS,"0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_syphillis,pregnancy_screening,,radio,Syphillis,"0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_gonorrhea,pregnancy_screening,,radio,Gonorrhea,"0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_chlamydia,pregnancy_screening,,radio,Chlamydia,"0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_rubella,pregnancy_screening,,radio,Rubella,"0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_varicella,pregnancy_screening,,radio,"Varicella Zoster Virus","0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_other_1,pregnancy_screening,,radio,"Other 1","0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_other_2,pregnancy_screening,,radio,"Other 2","0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_other_3,pregnancy_screening,,radio,"Other 3","0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_other_4,pregnancy_screening,,radio,"Other 4","0, Neg / unreactive | 1, Pos / reactive | 999, Unk | 888, Not tested",,,,,,,,,,j_additional_testing,,
k_other_1_name,pregnancy_screening,,text,"",,,,,,,"[k_other_1] = '0' or [k_other_1] = '1' or [k_other_1] = '999'",,,,,,
k_other_2_name,pregnancy_screening,,text,"",,,,,,,"[k_other_2] = '0' or [k_other_2] = '1' or [k_other_2] = '999'",,,,,,
k_other_3_name,pregnancy_screening,,text,"",,,,,,,"[k_other_3] = '0' or [k_other_3] = '1' or [k_other_3] = '999'",,,,,,
k_other_4_name,pregnancy_screening,,text,"",,,,,,,"[k_other_4] = '0' or [k_other_4] = '1' or [k_other_4] = '999'",,,,,,
k_comments,pregnancy_screening,,notes,Comments,,,,,,,,,,,,,
l_desc,complications_related_to_pregnancy,"During this pregnancy, did any of the following occur?
Â
",descriptive,"NOTE 1: In the event of a pregnancy loss, document on Pregnancy Loss form
NOTE 2: This form should include all pregnancy – complete with available information & update through to end preg
NOTE 3: Record all medications for COVID indication in COVID medications table on SARS-COV-2 HISTORY, MATERNAL TESTING, SYMPTOMS, TREATMENTS, & HOSPITALIZATONS THROUGH FOLLOW-UP forms
NOTE 4: Records all other medications in General Medications form
",,,,,,,,,,,,,
l_abstraction_complete,complications_related_to_pregnancy,,radio,"Data abstraction complete through delivery?","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_bleed,complications_related_to_pregnancy,,radio,"1. Bleeding","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_bleed_known1,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_bleed] = '1'",,RH,,,,
l_bleed_date1,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_bleed_known1] = '1'",,RH,,,,
l_bleed_month1,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known1] = '999'",,RH,,,,
l_bleed_ga1,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known1] = '999'",,RH,,,,
l_bleed_tri1,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known1] = '999'",,RH,,,,
l_bleed_known2,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_bleed_known1] = '1' or [l_bleed_known1] = '999'",,RH,,,,
l_bleed_date2,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_bleed_known2] = '1'",,RH,,,,
l_bleed_month2,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known2] = '999'",,RH,,,,
l_bleed_ga2,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known2] = '999'",,RH,,,,
l_bleed_tri2,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known2] = '999'",,RH,,,,
l_bleed_known3,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_bleed_known2] = '1' or [l_bleed_known2] = '999'",,RH,,,,
l_bleed_date3,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_bleed_known3] = '1'",,RH,,,,
l_bleed_month3,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known3] = '999'",,RH,,,,
l_bleed_ga3,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known3] = '999'",,RH,,,,
l_bleed_tri3,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known3] = '999'",,RH,,,,
l_bleed_known4,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_bleed_known3] = '1' or [l_bleed_known3] = '999'",,RH,,,,
l_bleed_date4,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_bleed_known4] = '1'",,RH,,,,
l_bleed_month4,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known4] = '999'",,RH,,,,
l_bleed_ga4,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known4] = '999'",,RH,,,,
l_bleed_tri4,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known4] = '999'",,RH,,,,
l_bleed_known5,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_bleed_known4] = '1' or [l_bleed_known4] = '999'",,RH,,,,
l_bleed_date5,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_bleed_known5] = '1'",,RH,,,,
l_bleed_unk5,complications_related_to_pregnancy,,text,"",,,,,,,"[l_bleed_known5] = '999'",,RH,,,,
l_bleed_month6,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known5] = '999'",,RH,,,,
l_bleed_ga6,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known5] = '999'",,RH,,,,
l_bleed_tri6,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_bleed_known5] = '999'",,RH,,,,
l_bleed_date6,complications_related_to_pregnancy,,notes,"List all other dates
If unknown, list month, GA or trimester
",,,,,,,"[l_bleed_known5] = '1' or [l_bleed_known5] = '999'",,RH,,,,
l_bleed_etiology,complications_related_to_pregnancy,,checkbox,"","1, Placental abruption | 2, Placenta previa | 3, Cervix | 998, Other, specify | 999, Unknown",,,,,,"[l_bleed] = '1'",,,,,,
l_bleed_etiology_s,complications_related_to_pregnancy,,text,"",,,,,,,"[l_bleed_etiology(998)] = '1'",,,,,,
l_bleed_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_bleed] = '1'",,RH,,,,
l_prog,complications_related_to_pregnancy,,radio,"2. Progesterone given to prevent premature birth","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_prog_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_prog] = '1'",,RH,,,,
l_prog_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_prog_known] = '1'",,RH,,,,
l_prog_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_prog_known] = '999'",,RH,,,,
l_prog_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_prog_known] = '999'",,RH,,,,
l_prog_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_prog_known] = '999'",,RH,,,,
l_prog_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_prog] = '1'",,RH,,,,
l_cerc,complications_related_to_pregnancy,,radio,"3. Cerclage","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_cerc_known1,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_cerc] = '1'",,RH,,,,
l_cerc_date_in,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_cerc_known1] = '1'",,RH,,,,
l_cerc_month_in,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_cerc_known1] = '999'",,RH,,,,
l_cerc_ga_in,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_cerc_known1] = '999'",,RH,,,,
l_cerc_tri_in,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_cerc_known1] = '999'",,RH,,,,
l_cerc_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_cerc] = '1'",,RH,,,,
l_rupt,complications_related_to_pregnancy,,radio,"4. Preterm premature rupture of membranes","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_rupt_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_rupt] = '1'",,RH,,,,
l_rupt_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_rupt_known] = '1'",,RH,,,,
l_rupt_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_rupt_known] = '999'",,RH,,,,
l_rupt_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_rupt_known] = '999'",,RH,,,,
l_rupt_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_rupt_known] = '999'",,RH,,,,
l_rupt_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_rupt] = '1'",,RH,,,,
l_pre,complications_related_to_pregnancy,,radio,"5. Preterm labour","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_pre_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_pre] = '1'",,RH,,,,
l_pre_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_pre_known] = '1'",,RH,,,,
l_pre_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_pre_known] = '999'",,RH,,,,
l_pre_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_pre_known] = '999'",,RH,,,,
l_pre_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_pre_known] = '999'",,RH,,,,
l_pre_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_pre] = '1'",,RH,,,,
l_chol,complications_related_to_pregnancy,,radio,"6. Cholestasis of pregnancy","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_chol_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_chol] = '1'",,RH,,,,
l_chol_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_chol_known] = '1'",,RH,,,,
l_chol_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_chol_known] = '999'",,RH,,,,
l_chol_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_chol_known] = '999'",,RH,,,,
l_chol_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_chol_known] = '999'",,RH,,,,
l_chol_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_chol] = '1'",,RH,,,,
l_htn,complications_related_to_pregnancy,,radio,"7. Hypertensive disorder of pregnancy","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_htn_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_htn] = '1'",,RH,,,,
l_htn_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_htn_known] = '1'",,RH,,,,
l_htn_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_htn_known] = '999'",,RH,,,,
l_htn_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_htn_known] = '999'",,RH,,,,
l_htn_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_htn_known] = '999'",,RH,,,,
l_htn_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_htn] = '1'",,RH,,,,
l_diab,complications_related_to_pregnancy,,radio,"8. Gestational diabetes","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_diab_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_diab] = '1'",,RH,,,,
l_diab_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_diab_known] = '1'",,RH,,,,
l_diab_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_diab_known] = '999'",,RH,,,,
l_diab_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_diab_known] = '999'",,RH,,,,
l_diab_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_diab_known] = '999'",,RH,,,,
l_diab_ins,complications_related_to_pregnancy,,radio,,"1, Diet controlled | 2, Insulin controlled | 3, Metformin | 999, Unknown",,,,,,"[l_diab] = '1'",,,,,,
l_diab_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_diab] = '1'",,RH,,,,
l_loss,complications_related_to_pregnancy,,radio,"9. Pregnancy Loss","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_loss_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_loss] = '1'",,RH,,,,
l_loss_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_loss_known] = '1'",,RH,,,,
l_loss_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_loss_known] = '999'",,RH,,,,
l_loss_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_loss_known] = '999'",,RH,,,,
l_loss_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_loss_known] = '999'",,RH,,,,
l_loss_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_loss] = '1'",,RH,,,,
l_loss_desc,complications_related_to_pregnancy,,descriptive,"DOCUMENT ON PREGNANCY LOSS FORM",,,,,,,"[l_loss] = '1'",,,,,,
l_oth1,complications_related_to_pregnancy,,radio,"10. Other ","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
l_oth1_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth1] = '1'",,RH,,,,
l_oth1_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth1] = '1'",,RH,,,,
l_oth1_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth1_known] = '1'",,RH,,,,
l_oth1_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth1_known] = '999'",,RH,,,,
l_oth1_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth1_known] = '999'",,RH,,,,
l_oth1_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth1_known] = '999'",,RH,,,,
l_oth1_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth1] = '1'",,RH,,,,
l_oth_add1,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth1] = '1'",,,,,,
l_oth2_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add1(1)] = '1'",,RH,,,,
l_oth2_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add1(1)] = '1'",,RH,,,,
l_oth2_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth2_known] = '1'",,RH,,,,
l_oth2_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth2_known] = '999'",,RH,,,,
l_oth2_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth2_known] = '999'",,RH,,,,
l_oth2_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth2_known] = '999'",,RH,,,,
l_oth2_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add1(1)] = '1'",,RH,,,,
l_oth_add2,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add1(1)] = '1'",,,,,,
l_oth3_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add2(1)] = '1'",,RH,,,,
l_oth3_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add2(1)] = '1'",,RH,,,,
l_oth3_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth3_known] = '1'",,RH,,,,
l_oth3_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth3_known] = '999'",,RH,,,,
l_oth3_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth3_known] = '999'",,RH,,,,
l_oth3_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth3_known] = '999'",,RH,,,,
l_oth3_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add2(1)] = '1'",,RH,,,,
l_oth_add3,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add2(1)] = '1'",,,,,,
l_oth4_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add3(1)] = '1'",,RH,,,,
l_oth4_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add3(1)] = '1'",,RH,,,,
l_oth4_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth4_known] = '1'",,RH,,,,
l_oth4_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth4_known] = '999'",,RH,,,,
l_oth4_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth4_known] = '999'",,RH,,,,
l_oth4_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth4_known] = '999'",,RH,,,,
l_oth4_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add3(1)] = '1'",,RH,,,,
l_oth_add4,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add3(1)] = '1'",,,,,,
l_oth5_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add4(1)] = '1'",,RH,,,,
l_oth5_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add4(1)] = '1'",,RH,,,,
l_oth5_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth5_known] = '1'",,RH,,,,
l_oth5_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth5_known] = '999'",,RH,,,,
l_oth5_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth5_known] = '999'",,RH,,,,
l_oth5_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth5_known] = '999'",,RH,,,,
l_oth5_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add4(1)] = '1'",,RH,,,,
l_oth_add5,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add4(1)] = '1'",,,,,,
l_oth6_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add5(1)] = '1'",,RH,,,,
l_oth6_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add5(1)] = '1'",,RH,,,,
l_oth6_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth6_known] = '1'",,RH,,,,
l_oth6_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth6_known] = '999'",,RH,,,,
l_oth6_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth6_known] = '999'",,RH,,,,
l_oth6_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth6_known] = '999'",,RH,,,,
l_oth6_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add5(1)] = '1'",,RH,,,,
l_oth_add6,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add5(1)] = '1'",,,,,,
l_oth7_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add6(1)] = '1'",,RH,,,,
l_oth7_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add6(1)] = '1'",,RH,,,,
l_oth7_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth7_known] = '1'",,RH,,,,
l_oth7_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth7_known] = '999'",,RH,,,,
l_oth7_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth7_known] = '999'",,RH,,,,
l_oth7_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth7_known] = '999'",,RH,,,,
l_oth7_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add6(1)] = '1'",,RH,,,,
l_oth_add7,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add6(1)] = '1'",,,,,,
l_oth8_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add7(1)] = '1'",,RH,,,,
l_oth8_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add7(1)] = '1'",,RH,,,,
l_oth8_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth8_known] = '1'",,RH,,,,
l_oth8_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth8_known] = '999'",,RH,,,,
l_oth8_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth8_known] = '999'",,RH,,,,
l_oth8_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth8_known] = '999'",,RH,,,,
l_oth8_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add7(1)] = '1'",,RH,,,,
l_oth_add8,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add7(1)] = '1'",,,,,,
l_oth9_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add8(1)] = '1'",,RH,,,,
l_oth9_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add8(1)] = '1'",,RH,,,,
l_oth9_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth9_known] = '1'",,RH,,,,
l_oth9_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth9_known] = '999'",,RH,,,,
l_oth9_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth9_known] = '999'",,RH,,,,
l_oth9_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth9_known] = '999'",,RH,,,,
l_oth9_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add8(1)] = '1'",,RH,,,,
l_oth_add9,complications_related_to_pregnancy,,checkbox,"","1,",,,,,,"[l_oth_add8(1)] = '1'",,,,,,
l_oth10_spec,complications_related_to_pregnancy,,text,"",,,,,,,"[l_oth_add9(1)] = '1'",,RH,,,,
l_oth10_known,complications_related_to_pregnancy,,radio,"","1, Known | 999, Unknown",,,,,,"[l_oth_add9(1)] = '1'",,RH,,,,
l_oth10_date,complications_related_to_pregnancy,,text,"",,,date_dmy,,,,"[l_oth10_known] = '1'",,RH,,,,
l_oth10_month,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth10_known] = '999'",,RH,,,,
l_oth10_ga,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth10_known] = '999'",,RH,,,,
l_oth10_tri,complications_related_to_pregnancy,,text,"",,"999 if unknown",,,,,"[l_oth10_known] = '999'",,RH,,,,
l_oth10_comments,complications_related_to_pregnancy,,notes,"",,,,,,,"[l_oth_add9(1)] = '1'",,RH,,,,
l_comments,complications_related_to_pregnancy," ",notes,"General comments",,,,,,,,,,,,,
m_desc,ultrasound_results_1,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno,ultrasound_results_1,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of,ultrasound_results_1,,text,"",,,number,1,10,,,,,,,,
m_date,ultrasound_results_1,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating,ultrasound_results_1,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements,ultrasound_results_1,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum,ultrasound_results_1,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen,ultrasound_results_1,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum,ultrasound_results_1,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen,ultrasound_results_1,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal,ultrasound_results_1,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt,ultrasound_results_1,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo,ultrasound_results_1,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly,ultrasound_results_1,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra,ultrasound_results_1,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent,ultrasound_results_1,,text,"",,,number,,,,"[m_intra] = '1'",,RH,,,,
m_placen,ultrasound_results_1,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa,ultrasound_results_1,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen] = '1'",,,,,,
m_placen_oth,ultrasound_results_1,,text,"",,,,,,,"[m_placen_previa] = '998'",,RH,,,,
m_anatom,ultrasound_results_1,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural,ultrasound_results_1,,checkbox,"","1,",,,,,,"[m_anatom] = '1'",,RH,,,,
m_anatom_neural_s,ultrasound_results_1,,text,"",,,,,,,"[m_anatom_neural(1)] = '1'",,RH,,,,
m_anatom_heart,ultrasound_results_1,,checkbox,"","1,",,,,,,"[m_anatom] = '1'",,RH,,,,
m_anatom_heart_s,ultrasound_results_1,,text,"",,,,,,,"[m_anatom_heart(1)] = '1'",,RH,,,,
m_anatom_poly,ultrasound_results_1,,checkbox,"","1,",,,,,,"[m_anatom] = '1'",,RH,,,,
m_anatom_poly_s,ultrasound_results_1,,text,"",,,,,,,"[m_anatom_poly(1)] = '1'",,RH,,,,
m_anatom_cleft,ultrasound_results_1,,checkbox,"","1,",,,,,,"[m_anatom] = '1'",,RH,,,,
m_anatom_cleft_s,ultrasound_results_1,,text,"",,,,,,,"[m_anatom_cleft(1)] = '1'",,RH,,,,
m_anatom_cereb,ultrasound_results_1,,checkbox,"","1,",,,,,,"[m_anatom] = '1'",,RH,,,,
m_anatom_cereb_s,ultrasound_results_1,,text,"",,,,,,,"[m_anatom_cereb(1)] = '1'",,RH,,,,
m_anatom_oth,ultrasound_results_1,,checkbox,"","1,",,,,,,"[m_anatom] = '1'",,RH,,,,
m_anatom_oth_s,ultrasound_results_1,,text,"",,,,,,,"[m_anatom_oth(1)] = '1'",,RH,,,,
m_other,ultrasound_results_1,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s,ultrasound_results_1,,notes,"",,,,,,,"[m_other] = '1'",,RH,,,,
m_comments,ultrasound_results_1," ",notes,"General comments",,,,,,,,,,,,,
m_desc_2,ultrasound_results_2,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_2,ultrasound_results_2,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_2,ultrasound_results_2,,text,"",,,number,1,10,,,,,,,,
m_date_2,ultrasound_results_2,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_2,ultrasound_results_2,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_2,ultrasound_results_2,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_2,ultrasound_results_2,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_2,ultrasound_results_2,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_2,ultrasound_results_2,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_2,ultrasound_results_2,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_2,ultrasound_results_2,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_2,ultrasound_results_2,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_2,ultrasound_results_2,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_2,ultrasound_results_2,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_2,ultrasound_results_2,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_2,ultrasound_results_2,,text,"",,,number,,,,"[m_intra_2] = '1'",,RH,,,,
m_placen_2,ultrasound_results_2,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_2,ultrasound_results_2,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_2] = '1'",,,,,,
m_placen_oth_2,ultrasound_results_2,,text,"",,,,,,,"[m_placen_previa_2] = '998'",,RH,,,,
m_anatom_2,ultrasound_results_2,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_2,ultrasound_results_2,,checkbox,"","1,",,,,,,"[m_anatom_2] = '1'",,RH,,,,
m_anatom_neural_s_2,ultrasound_results_2,,text,"",,,,,,,"[m_anatom_neural_2(1)] = '1'",,RH,,,,
m_anatom_heart_2,ultrasound_results_2,,checkbox,"","1,",,,,,,"[m_anatom_2] = '1'",,RH,,,,
m_anatom_heart_s_2,ultrasound_results_2,,text,"",,,,,,,"[m_anatom_heart_2(1)] = '1'",,RH,,,,
m_anatom_poly_2,ultrasound_results_2,,checkbox,"","1,",,,,,,"[m_anatom_2] = '1'",,RH,,,,
m_anatom_poly_s_2,ultrasound_results_2,,text,"",,,,,,,"[m_anatom_poly_2(1)] = '1'",,RH,,,,
m_anatom_cleft_2,ultrasound_results_2,,checkbox,"","1,",,,,,,"[m_anatom_2] = '1'",,RH,,,,
m_anatom_cleft_s_2,ultrasound_results_2,,text,"",,,,,,,"[m_anatom_cleft_2(1)] = '1'",,RH,,,,
m_anatom_cereb_2,ultrasound_results_2,,checkbox,"","1,",,,,,,"[m_anatom_2] = '1'",,RH,,,,
m_anatom_cereb_s_2,ultrasound_results_2,,text,"",,,,,,,"[m_anatom_cereb_2(1)] = '1'",,RH,,,,
m_anatom_oth_2,ultrasound_results_2,,checkbox,"","1,",,,,,,"[m_anatom_2] = '1'",,RH,,,,
m_anatom_oth_s_2,ultrasound_results_2,,text,"",,,,,,,"[m_anatom_oth_2(1)] = '1'",,RH,,,,
m_other_2,ultrasound_results_2,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_2,ultrasound_results_2,,notes,"",,,,,,,"[m_other_2] = '1'",,RH,,,,
m_comments_2,ultrasound_results_2," ",notes,"General comments",,,,,,,,,,,,,
m_desc_3,ultrasound_results_3,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_3,ultrasound_results_3,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_3,ultrasound_results_3,,text,"",,,number,1,10,,,,,,,,
m_date_3,ultrasound_results_3,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_3,ultrasound_results_3,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_3,ultrasound_results_3,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_3,ultrasound_results_3,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_3,ultrasound_results_3,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_3,ultrasound_results_3,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_3,ultrasound_results_3,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_3,ultrasound_results_3,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_3,ultrasound_results_3,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_3,ultrasound_results_3,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_3,ultrasound_results_3,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_3,ultrasound_results_3,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_3,ultrasound_results_3,,text,"",,,number,,,,"[m_intra_3] = '1'",,RH,,,,
m_placen_3,ultrasound_results_3,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_3,ultrasound_results_3,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_3] = '1'",,,,,,
m_placen_oth_3,ultrasound_results_3,,text,"",,,,,,,"[m_placen_previa_3] = '998'",,RH,,,,
m_anatom_3,ultrasound_results_3,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_3,ultrasound_results_3,,checkbox,"","1,",,,,,,"[m_anatom_3] = '1'",,RH,,,,
m_anatom_neural_s_3,ultrasound_results_3,,text,"",,,,,,,"[m_anatom_neural_3(1)] = '1'",,RH,,,,
m_anatom_heart_3,ultrasound_results_3,,checkbox,"","1,",,,,,,"[m_anatom_3] = '1'",,RH,,,,
m_anatom_heart_s_3,ultrasound_results_3,,text,"",,,,,,,"[m_anatom_heart_3(1)] = '1'",,RH,,,,
m_anatom_poly_3,ultrasound_results_3,,checkbox,"","1,",,,,,,"[m_anatom_3] = '1'",,RH,,,,
m_anatom_poly_s_3,ultrasound_results_3,,text,"",,,,,,,"[m_anatom_poly_3(1)] = '1'",,RH,,,,
m_anatom_cleft_3,ultrasound_results_3,,checkbox,"","1,",,,,,,"[m_anatom_3] = '1'",,RH,,,,
m_anatom_cleft_s_3,ultrasound_results_3,,text,"",,,,,,,"[m_anatom_cleft_3(1)] = '1'",,RH,,,,
m_anatom_cereb_3,ultrasound_results_3,,checkbox,"","1,",,,,,,"[m_anatom_3] = '1'",,RH,,,,
m_anatom_cereb_s_3,ultrasound_results_3,,text,"",,,,,,,"[m_anatom_cereb_3(1)] = '1'",,RH,,,,
m_anatom_oth_3,ultrasound_results_3,,checkbox,"","1,",,,,,,"[m_anatom_3] = '1'",,RH,,,,
m_anatom_oth_s_3,ultrasound_results_3,,text,"",,,,,,,"[m_anatom_oth_3(1)] = '1'",,RH,,,,
m_other_3,ultrasound_results_3,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_3,ultrasound_results_3,,notes,"",,,,,,,"[m_other_3] = '1'",,RH,,,,
m_comments_3,ultrasound_results_3," ",notes,"General comments",,,,,,,,,,,,,
m_desc_4,ultrasound_results_4,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_4,ultrasound_results_4,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_4,ultrasound_results_4,,text,"",,,number,1,10,,,,,,,,
m_date_4,ultrasound_results_4,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_4,ultrasound_results_4,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_4,ultrasound_results_4,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_4,ultrasound_results_4,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_4,ultrasound_results_4,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_4,ultrasound_results_4,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_4,ultrasound_results_4,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_4,ultrasound_results_4,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_4,ultrasound_results_4,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_4,ultrasound_results_4,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_4,ultrasound_results_4,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_4,ultrasound_results_4,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_4,ultrasound_results_4,,text,"",,,number,,,,"[m_intra_4] = '1'",,RH,,,,
m_placen_4,ultrasound_results_4,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_4,ultrasound_results_4,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_4] = '1'",,,,,,
m_placen_oth_4,ultrasound_results_4,,text,"",,,,,,,"[m_placen_previa_4] = '998'",,RH,,,,
m_anatom_4,ultrasound_results_4,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_4,ultrasound_results_4,,checkbox,"","1,",,,,,,"[m_anatom_4] = '1'",,RH,,,,
m_anatom_neural_s_4,ultrasound_results_4,,text,"",,,,,,,"[m_anatom_neural_4(1)] = '1'",,RH,,,,
m_anatom_heart_4,ultrasound_results_4,,checkbox,"","1,",,,,,,"[m_anatom_4] = '1'",,RH,,,,
m_anatom_heart_s_4,ultrasound_results_4,,text,"",,,,,,,"[m_anatom_heart_4(1)] = '1'",,RH,,,,
m_anatom_poly_4,ultrasound_results_4,,checkbox,"","1,",,,,,,"[m_anatom_4] = '1'",,RH,,,,
m_anatom_poly_s_4,ultrasound_results_4,,text,"",,,,,,,"[m_anatom_poly_4(1)] = '1'",,RH,,,,
m_anatom_cleft_4,ultrasound_results_4,,checkbox,"","1,",,,,,,"[m_anatom_4] = '1'",,RH,,,,
m_anatom_cleft_s_4,ultrasound_results_4,,text,"",,,,,,,"[m_anatom_cleft_4(1)] = '1'",,RH,,,,
m_anatom_cereb_4,ultrasound_results_4,,checkbox,"","1,",,,,,,"[m_anatom_4] = '1'",,RH,,,,
m_anatom_cereb_s_4,ultrasound_results_4,,text,"",,,,,,,"[m_anatom_cereb_4(1)] = '1'",,RH,,,,
m_anatom_oth_4,ultrasound_results_4,,checkbox,"","1,",,,,,,"[m_anatom_4] = '1'",,RH,,,,
m_anatom_oth_s_4,ultrasound_results_4,,text,"",,,,,,,"[m_anatom_oth_4(1)] = '1'",,RH,,,,
m_other_4,ultrasound_results_4,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_4,ultrasound_results_4,,notes,"",,,,,,,"[m_other_4] = '1'",,RH,,,,
m_comments_4,ultrasound_results_4," ",notes,"General comments",,,,,,,,,,,,,
m_desc_5,ultrasound_results_5,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_5,ultrasound_results_5,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_5,ultrasound_results_5,,text,"",,,number,1,10,,,,,,,,
m_date_5,ultrasound_results_5,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_5,ultrasound_results_5,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_5,ultrasound_results_5,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_5,ultrasound_results_5,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_5,ultrasound_results_5,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_5,ultrasound_results_5,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_5,ultrasound_results_5,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietam_5,ultrasound_results_5,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_5,ultrasound_results_5,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_5,ultrasound_results_5,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_5,ultrasound_results_5,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_5,ultrasound_results_5,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_5,ultrasound_results_5,,text,"",,,number,,,,"[m_intra_5] = '1'",,RH,,,,
m_placen_5,ultrasound_results_5,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_5,ultrasound_results_5,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_5] = '1'",,,,,,
m_placen_oth_5,ultrasound_results_5,,text,"",,,,,,,"[m_placen_previa_5] = '998'",,RH,,,,
m_anatom_5,ultrasound_results_5,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_5,ultrasound_results_5,,checkbox,"","1,",,,,,,"[m_anatom_5] = '1'",,RH,,,,
m_anatom_neural_s_5,ultrasound_results_5,,text,"",,,,,,,"[m_anatom_neural_5(1)] = '1'",,RH,,,,
m_anatom_heart_5,ultrasound_results_5,,checkbox,"","1,",,,,,,"[m_anatom_5] = '1'",,RH,,,,
m_anatom_heart_s_5,ultrasound_results_5,,text,"",,,,,,,"[m_anatom_heart_5(1)] = '1'",,RH,,,,
m_anatom_poly_5,ultrasound_results_5,,checkbox,"","1,",,,,,,"[m_anatom_5] = '1'",,RH,,,,
m_anatom_poly_s_5,ultrasound_results_5,,text,"",,,,,,,"[m_anatom_poly_5(1)] = '1'",,RH,,,,
m_anatom_cleft_5,ultrasound_results_5,,checkbox,"","1,",,,,,,"[m_anatom_5] = '1'",,RH,,,,
m_anatom_cleft_s_5,ultrasound_results_5,,text,"",,,,,,,"[m_anatom_cleft_5(1)] = '1'",,RH,,,,
m_anatom_cereb_5,ultrasound_results_5,,checkbox,"","1,",,,,,,"[m_anatom_5] = '1'",,RH,,,,
m_anatom_cereb_s_5,ultrasound_results_5,,text,"",,,,,,,"[m_anatom_cereb_5(1)] = '1'",,RH,,,,
m_anatom_oth_5,ultrasound_results_5,,checkbox,"","1,",,,,,,"[m_anatom_5] = '1'",,RH,,,,
m_anatom_oth_s_5,ultrasound_results_5,,text,"",,,,,,,"[m_anatom_oth_5(1)] = '1'",,RH,,,,
m_other_5,ultrasound_results_5,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_5,ultrasound_results_5,,notes,"",,,,,,,"[m_other_5] = '1'",,RH,,,,
m_comments_5,ultrasound_results_5," ",notes,"General comments",,,,,,,,,,,,,
m_desc_6,ultrasound_results_6,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_6,ultrasound_results_6,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_6,ultrasound_results_6,,text,"",,,number,1,10,,,,,,,,
m_date_6,ultrasound_results_6,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_6,ultrasound_results_6,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_6,ultrasound_results_6,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_6,ultrasound_results_6,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_6,ultrasound_results_6,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_6,ultrasound_results_6,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_6,ultrasound_results_6,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_6,ultrasound_results_6,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_6,ultrasound_results_6,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_6,ultrasound_results_6,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_6,ultrasound_results_6,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_6,ultrasound_results_6,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_6,ultrasound_results_6,,text,"",,,number,,,,"[m_intra_6] = '1'",,RH,,,,
m_placen_6,ultrasound_results_6,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_6,ultrasound_results_6,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_6] = '1'",,,,,,
m_placen_oth_6,ultrasound_results_6,,text,"",,,,,,,"[m_placen_previa_6] = '998'",,RH,,,,
m_anatom_6,ultrasound_results_6,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_6,ultrasound_results_6,,checkbox,"","1,",,,,,,"[m_anatom_6] = '1'",,RH,,,,
m_anatom_neural_s_6,ultrasound_results_6,,text,"",,,,,,,"[m_anatom_neural_6(1)] = '1'",,RH,,,,
m_anatom_heart_6,ultrasound_results_6,,checkbox,"","1,",,,,,,"[m_anatom_6] = '1'",,RH,,,,
m_anatom_heart_s_6,ultrasound_results_6,,text,"",,,,,,,"[m_anatom_heart_6(1)] = '1'",,RH,,,,
m_anatom_poly_6,ultrasound_results_6,,checkbox,"","1,",,,,,,"[m_anatom_6] = '1'",,RH,,,,
m_anatom_poly_s_6,ultrasound_results_6,,text,"",,,,,,,"[m_anatom_poly_6(1)] = '1'",,RH,,,,
m_anatom_cleft_6,ultrasound_results_6,,checkbox,"","1,",,,,,,"[m_anatom_6] = '1'",,RH,,,,
m_anatom_cleft_s_6,ultrasound_results_6,,text,"",,,,,,,"[m_anatom_cleft_6(1)] = '1'",,RH,,,,
m_anatom_cereb_6,ultrasound_results_6,,checkbox,"","1,",,,,,,"[m_anatom_6] = '1'",,RH,,,,
m_anatom_cereb_s_6,ultrasound_results_6,,text,"",,,,,,,"[m_anatom_cereb_6(1)] = '1'",,RH,,,,
m_anatom_oth_6,ultrasound_results_6,,checkbox,"","1,",,,,,,"[m_anatom_6] = '1'",,RH,,,,
m_anatom_oth_s_6,ultrasound_results_6,,text,"",,,,,,,"[m_anatom_oth_6(1)] = '1'",,RH,,,,
m_other_6,ultrasound_results_6,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_6,ultrasound_results_6,,notes,"",,,,,,,"[m_other_6] = '1'",,RH,,,,
m_comments_6,ultrasound_results_6,,notes,"General comments",,,,,,,,,,,,,
m_desc_7,ultrasound_results_7,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_7,ultrasound_results_7,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_7,ultrasound_results_7,,text,"",,,number,1,10,,,,,,,,
m_date_7,ultrasound_results_7,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_7,ultrasound_results_7,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_7,ultrasound_results_7,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_7,ultrasound_results_7,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_7,ultrasound_results_7,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_7,ultrasound_results_7,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_7,ultrasound_results_7,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_7,ultrasound_results_7,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_7,ultrasound_results_7,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_7,ultrasound_results_7,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_7,ultrasound_results_7,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_7,ultrasound_results_7,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_7,ultrasound_results_7,,text,"",,,number,,,,"[m_intra_7] = '1'",,RH,,,,
m_placen_7,ultrasound_results_7,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_7,ultrasound_results_7,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_7] = '1'",,,,,,
m_placen_oth_7,ultrasound_results_7,,text,"",,,,,,,"[m_placen_previa_7] = '998'",,RH,,,,
m_anatom_7,ultrasound_results_7,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_7,ultrasound_results_7,,checkbox,"","1,",,,,,,"[m_anatom_7] = '1'",,RH,,,,
m_anatom_neural_s_7,ultrasound_results_7,,text,"",,,,,,,"[m_anatom_neural_7(1)] = '1'",,RH,,,,
m_anatom_heart_7,ultrasound_results_7,,checkbox,"","1,",,,,,,"[m_anatom_7] = '1'",,RH,,,,
m_anatom_heart_s_7,ultrasound_results_7,,text,"",,,,,,,"[m_anatom_heart_7(1)] = '1'",,RH,,,,
m_anatom_poly_7,ultrasound_results_7,,checkbox,"","1,",,,,,,"[m_anatom_7] = '1'",,RH,,,,
m_anatom_poly_s_7,ultrasound_results_7,,text,"",,,,,,,"[m_anatom_poly_7(1)] = '1'",,RH,,,,
m_anatom_cleft_7,ultrasound_results_7,,checkbox,"","1,",,,,,,"[m_anatom_7] = '1'",,RH,,,,
m_anatom_cleft_s_7,ultrasound_results_7,,text,"",,,,,,,"[m_anatom_cleft_7(1)] = '1'",,RH,,,,
m_anatom_cereb_7,ultrasound_results_7,,checkbox,"","1,",,,,,,"[m_anatom_7] = '1'",,RH,,,,
m_anatom_cereb_s_7,ultrasound_results_7,,text,"",,,,,,,"[m_anatom_cereb_7(1)] = '1'",,RH,,,,
m_anatom_oth_7,ultrasound_results_7,,checkbox,"","1,",,,,,,"[m_anatom_7] = '1'",,RH,,,,
m_anatom_oth_s_7,ultrasound_results_7,,text,"",,,,,,,"[m_anatom_oth_7(1)] = '1'",,RH,,,,
m_other_7,ultrasound_results_7,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_7,ultrasound_results_7,,notes,"",,,,,,,"[m_other_7] = '1'",,RH,,,,
m_comments_7,ultrasound_results_7,,notes,"General comments",,,,,,,,,,,,,
m_desc_8,ultrasound_results_8,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_8,ultrasound_results_8,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_8,ultrasound_results_8,,text,"",,,number,1,10,,,,,,,,
m_date_8,ultrasound_results_8,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_8,ultrasound_results_8,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_8,ultrasound_results_8,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_8,ultrasound_results_8,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_8,ultrasound_results_8,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_8,ultrasound_results_8,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_8,ultrasound_results_8,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_8,ultrasound_results_8,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_8,ultrasound_results_8,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_8,ultrasound_results_8,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_8,ultrasound_results_8,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_8,ultrasound_results_8,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_8,ultrasound_results_8,,text,"",,,number,,,,"[m_intra_8] = '1'",,RH,,,,
m_placen_8,ultrasound_results_8,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_8,ultrasound_results_8,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_8] = '1'",,,,,,
m_placen_oth_8,ultrasound_results_8,,text,"",,,,,,,"[m_placen_previa_8] = '998'",,RH,,,,
m_anatom_8,ultrasound_results_8,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_8,ultrasound_results_8,,checkbox,"","1,",,,,,,"[m_anatom_8] = '1'",,RH,,,,
m_anatom_neural_s_8,ultrasound_results_8,,text,"",,,,,,,"[m_anatom_neural_8(1)] = '1'",,RH,,,,
m_anatom_heart_8,ultrasound_results_8,,checkbox,"","1,",,,,,,"[m_anatom_8] = '1'",,RH,,,,
m_anatom_heart_s_8,ultrasound_results_8,,text,"",,,,,,,"[m_anatom_heart_8(1)] = '1'",,RH,,,,
m_anatom_poly_8,ultrasound_results_8,,checkbox,"","1,",,,,,,"[m_anatom_8] = '1'",,RH,,,,
m_anatom_poly_s_8,ultrasound_results_8,,text,"",,,,,,,"[m_anatom_poly_8(1)] = '1'",,RH,,,,
m_anatom_cleft_8,ultrasound_results_8,,checkbox,"","1,",,,,,,"[m_anatom_8] = '1'",,RH,,,,
m_anatom_cleft_s_8,ultrasound_results_8,,text,"",,,,,,,"[m_anatom_cleft_8(1)] = '1'",,RH,,,,
m_anatom_cereb_8,ultrasound_results_8,,checkbox,"","1,",,,,,,"[m_anatom_8] = '1'",,RH,,,,
m_anatom_cereb_s_8,ultrasound_results_8,,text,"",,,,,,,"[m_anatom_cereb_8(1)] = '1'",,RH,,,,
m_anatom_oth_8,ultrasound_results_8,,checkbox,"","1,",,,,,,"[m_anatom_8] = '1'",,RH,,,,
m_anatom_oth_s_8,ultrasound_results_8,,text,"",,,,,,,"[m_anatom_oth_8(1)] = '1'",,RH,,,,
m_other_8,ultrasound_results_8,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_8,ultrasound_results_8,,notes,"",,,,,,,"[m_other_8] = '1'",,RH,,,,
m_comments_8,ultrasound_results_8," ",notes,"General comments",,,,,,,,,,,,,
m_desc_9,ultrasound_results_9,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_9,ultrasound_results_9,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_9,ultrasound_results_9,,text,"",,,number,1,10,,,,,,,,
m_date_9,ultrasound_results_9,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_9,ultrasound_results_9,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_9,ultrasound_results_9,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_9,ultrasound_results_9,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_9,ultrasound_results_9,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_9,ultrasound_results_9,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_9,ultrasound_results_9,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_9,ultrasound_results_9,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_9,ultrasound_results_9,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_9,ultrasound_results_9,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_9,ultrasound_results_9,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_9,ultrasound_results_9,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_9,ultrasound_results_9,,text,"",,,number,,,,"[m_intra_9] = '1'",,RH,,,,
m_placen_9,ultrasound_results_9,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_9,ultrasound_results_9,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_9] = '1'",,,,,,
m_placen_oth_9,ultrasound_results_9,,text,"",,,,,,,"[m_placen_previa_9] = '998'",,RH,,,,
m_anatom_9,ultrasound_results_9,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_9,ultrasound_results_9,,checkbox,"","1,",,,,,,"[m_anatom_9] = '1'",,RH,,,,
m_anatom_neural_s_9,ultrasound_results_9,,text,"",,,,,,,"[m_anatom_neural_9(1)] = '1'",,RH,,,,
m_anatom_heart_9,ultrasound_results_9,,checkbox,"","1,",,,,,,"[m_anatom_9] = '1'",,RH,,,,
m_anatom_heart_s_9,ultrasound_results_9,,text,"",,,,,,,"[m_anatom_heart_9(1)] = '1'",,RH,,,,
m_anatom_poly_9,ultrasound_results_9,,checkbox,"","1,",,,,,,"[m_anatom_9] = '1'",,RH,,,,
m_anatom_poly_s_9,ultrasound_results_9,,text,"",,,,,,,"[m_anatom_poly_9(1)] = '1'",,RH,,,,
m_anatom_cleft_9,ultrasound_results_9,,checkbox,"","1,",,,,,,"[m_anatom_9] = '1'",,RH,,,,
m_anatom_cleft_s_9,ultrasound_results_9,,text,"",,,,,,,"[m_anatom_cleft_9(1)] = '1'",,RH,,,,
m_anatom_cereb_9,ultrasound_results_9,,checkbox,"","1,",,,,,,"[m_anatom_9] = '1'",,RH,,,,
m_anatom_cereb_s_9,ultrasound_results_9,,text,"",,,,,,,"[m_anatom_cereb_9(1)] = '1'",,RH,,,,
m_anatom_oth_9,ultrasound_results_9,,checkbox,"","1,",,,,,,"[m_anatom_9] = '1'",,RH,,,,
m_anatom_oth_s_9,ultrasound_results_9,,text,"",,,,,,,"[m_anatom_oth_9(1)] = '1'",,RH,,,,
m_other_9,ultrasound_results_9,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_9,ultrasound_results_9,,notes,"",,,,,,,"[m_other_9] = '1'",,RH,,,,
m_comments_9,ultrasound_results_9," ",notes,"General comments",,,,,,,,,,,,,
m_desc_10,ultrasound_results_10,,descriptive,"Complete separate form for each ultrasound",,,,,,,,,,,,,
m_usno_10,ultrasound_results_10,,text,"Ultrasound #",,,number,1,10,,,,,,,,
m_usno_of_10,ultrasound_results_10,,text,"",,,number,1,10,,,,,,,,
m_date_10,ultrasound_results_10,,text,"Date of ultrasound",,,date_dmy,,,,,,,,,,
m_dating_10,ultrasound_results_10,,radio,"Dating ultrasound","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
m_measurements_10,ultrasound_results_10,,descriptive,Measurements,,,,,,,,,,,,,
m_headcircum_10,ultrasound_results_10,,text,"",,"999 if unknown",number,,,,,,,,,,
m_femurlen_10,ultrasound_results_10,,text,"",,"999 if unknown",number,,,,,,,,,,
m_abdocircum_10,ultrasound_results_10,,text,"",,"999 if unknown",number,,,,,,,,,,
m_crownlen_10,ultrasound_results_10,,text,"",,"999 if unknown",number,,,,,,,,,,
m_biparietal_10,ultrasound_results_10,,text,"",,"999 if unknown",number,,,,,,,,,,
m_estfetalwt_10,ultrasound_results_10,,text,"",,"999 if unknown",number,,,,,,,,,,
m_oligo_10,ultrasound_results_10,,radio,"Oligohydramnios (low fluid)*","0, No | 1, Yes | 999, Unk","*single deepest pocket < 2 cm or amniotic fluid index < 5 cm (or lab diagnosis)",,,,,,,RH,,,,
m_poly_10,ultrasound_results_10,,radio,"Polyhydramnios (high fluid)**","0, No | 1, Yes | 999, Unk","**single deepest pocket >8 cm or amniotic fluid index ?25 cm (or lab diagnosis)",,,,,,,RH,,,,
m_intra_10,ultrasound_results_10,,radio,"Intrauterine growth restriction***","0, No | 1, Yes | 999, Unk","*** AC/EFW < 3rd percentile ",,,,,,,RH,,,,
m_intra_percent_10,ultrasound_results_10,,text,"",,,number,,,,"[m_intra_10] = '1'",,RH,,,,
m_placen_10,ultrasound_results_10,,radio,"Placental abnormality","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_placen_previa_10,ultrasound_results_10,,radio,"","1, Placenta previa | 998, Other | 999, Unknown",,,,,,"[m_placen_10] = '1'",,,,,,
m_placen_oth_10,ultrasound_results_10,,text,"",,,,,,,"[m_placen_previa_10] = '998'",,RH,,,,
m_anatom_10,ultrasound_results_10,,radio,"Anatomic abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_anatom_neural_10,ultrasound_results_10,,checkbox,"","1,",,,,,,"[m_anatom_10] = '1'",,RH,,,,
m_anatom_neural_s_10,ultrasound_results_10,,text,"",,,,,,,"[m_anatom_neural_10(1)] = '1'",,RH,,,,
m_anatom_heart_10,ultrasound_results_10,,checkbox,"","1,",,,,,,"[m_anatom_10] = '1'",,RH,,,,
m_anatom_heart_s_10,ultrasound_results_10,,text,"",,,,,,,"[m_anatom_heart_10(1)] = '1'",,RH,,,,
m_anatom_poly_10,ultrasound_results_10,,checkbox,"","1,",,,,,,"[m_anatom_10] = '1'",,RH,,,,
m_anatom_poly_s_10,ultrasound_results_10,,text,"",,,,,,,"[m_anatom_poly_10(1)] = '1'",,RH,,,,
m_anatom_cleft_10,ultrasound_results_10,,checkbox,"","1,",,,,,,"[m_anatom_10] = '1'",,RH,,,,
m_anatom_cleft_s_10,ultrasound_results_10,,text,"",,,,,,,"[m_anatom_cleft_10(1)] = '1'",,RH,,,,
m_anatom_cereb_10,ultrasound_results_10,,checkbox,"","1,",,,,,,"[m_anatom_10] = '1'",,RH,,,,
m_anatom_cereb_s_10,ultrasound_results_10,,text,"",,,,,,,"[m_anatom_cereb_10(1)] = '1'",,RH,,,,
m_anatom_oth_10,ultrasound_results_10,,checkbox,"","1,",,,,,,"[m_anatom_10] = '1'",,RH,,,,
m_anatom_oth_s_10,ultrasound_results_10,,text,"",,,,,,,"[m_anatom_oth_10(1)] = '1'",,RH,,,,
m_other_10,ultrasound_results_10,,radio,"Other abnormalities","0, No | 1, Yes | 999, Unk",,,,,,,,RH,,,,
m_other_s_10,ultrasound_results_10,,notes,"",,,,,,,"[m_other_10] = '1'",,RH,,,,
m_comments_10,ultrasound_results_10," ",notes,"General comments",,,,,,,,,,,,,
n_flu,immunizations,"Relevant immunizations",radio,"Received an Influenza vaccine in this season?","1, Yes | 0, No | 999, Unknown",,,,,,,,LH,,,,
n_flu_date,immunizations,,text,"If yes, date of immunization - if available
",,,date_dmy,,,,"[n_flu] = '1'",,RH,,,,
n_tdap,immunizations,,radio,"Received a TDAP vaccine this pregnancy?","1, Yes | 0, No | 999, Unknown",,,,,,,,LH,,,,
n_tdap_date,immunizations,,text,"If yes, date of immunization - if available
",,,date_dmy,,,,"[n_tdap] = '1'",,RH,,,,
n_covid,immunizations,,radio,"History of COVID vaccine?","1, Yes | 0, No | 999, Unknown",,,,,,,,LH,,,,
n_covid_inpreg,immunizations,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[n_covid] = '1'",,RH,,,,
n_covid_which,immunizations,,text,"",,,,,,,"[n_covid] = '1'",,RH,,,,
n_covid_date,immunizations,,text,"If yes, date of immunization - if available
",,,date_dmy,,,,"[n_covid] = '1'",,RH,,,,
n_other,immunizations,,radio,"Has the case received any other vaccines during pregnancy?","1, Yes | 0, No | 999, Unknown",,,,,,,,LH,,,,
n_other_date,immunizations,,text,"If yes, date of immunization - if available
",,,date_dmy,,,,"[n_other] = '1'",,RH,,,,
n_comments,immunizations," ",notes,"General comments",,,,,,,,,,,,,
o_loss,pregnancy_loss,,radio,"Was there a pregnancy loss?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
o_desc,pregnancy_loss,,dropdown,"NOTE: Please complete in the event of pregnancy loss. If multiple fetuses, specify fetus A/B/C.
","1, A | 2, B | 3, C",,,,,,,,LV,,,,
o_date,pregnancy_loss,,text,"Date of diagnosis of intrauterine fetal demise/ miscarriage/ or termination",,,date_dmy,,,,"[o_loss] = '1'",,RH,,,,
o_ga,pregnancy_loss,,text,"Gestational age at time of loss - weeks",,"999 if unknown",number0-100,,,,"[o_loss] = '1'",,RH,,,,
o_ga_days,pregnancy_loss,,text,"Gestational age at time of loss - days",,"999 if unknown",number0-100,,,,"[o_loss] = '1'",,RH,,,,
o_elective,pregnancy_loss,,radio,"Elective termination?","0, No | 1, Yes | 999, Unknown",,,,,,"[o_loss] = '1'",,,,n_type,,
o_spont,pregnancy_loss,,radio,"Spontaneous termination?","0, No | 1, Yes | 999, Unknown",,,,,,"[o_loss] = '1'",,,,n_type,,
o_sb,pregnancy_loss,,radio,"Still birth / intrauterine demise (greater than 20 weeks)?","0, No | 1, Yes | 999, Unknown",,,,,,"[o_loss] = '1'",,,,n_type,,
o_sb_time,pregnancy_loss,,radio,"","1, Antepartum | 2, Intrapartum | 999, Unknown",,,,,,"[o_sb] = '1'",,,,,,
o_autopsy,pregnancy_loss,,radio,"Autopsy completed?","0, No | 1, Yes | 999, Unknown",,,,,,"[o_loss] = '1'",,RH,,,,
o_autopsy_finding,pregnancy_loss,,notes,"",,,,,,,"[o_autopsy] = '1'",,RH,,,,
o_autopsy_diag,pregnancy_loss,,notes,"Pathologic including cytogenetic diagnoses
",,,,,,,"[o_autopsy] = '1'",,RH,,,,
o_autopsy_cause,pregnancy_loss,,notes,"",,,,,,,"[o_autopsy] = '1'",,RH,,,,
o_pol,pregnancy_loss,,radio,"SARS-COV-2 Products of loss testing? ","0, No | 1, Yes | 999, Unknown",,,,,,"[o_loss] = '1'",,RH,,,,
o_pol_dec,pregnancy_loss,,checkbox,"","1,",,,,,,"[o_pol] = '1'",,,,,,
o_pol_dec_col_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_dec(1)] = '1'",,,,,,
o_pol_dec_col_t,pregnancy_loss,,text,"",,,time,,,,"[o_pol_dec(1)] = '1'",,,,,,
o_pol_dec_rep_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_dec(1)] = '1'",,,,,,
o_pol_dec_test,pregnancy_loss,,text,"",,,,,,,"[o_pol_dec(1)] = '1'",,,,,,
o_pol_dec_result,pregnancy_loss,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 999, Unknown",,,,,,"[o_pol_dec(1)] = '1'",,,,,,
o_pol_plac,pregnancy_loss,,checkbox,"","1,",,,,,,"[o_pol] = '1'",,,,,,
o_pol_plac_col_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_plac(1)] = '1'",,,,,,
o_pol_plac_col_t,pregnancy_loss,,text,"",,,time,,,,"[o_pol_plac(1)] = '1'",,,,,,
o_pol_plac_rep_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_plac(1)] = '1'",,,,,,
o_pol_plac_test,pregnancy_loss,,text,"",,,,,,,"[o_pol_plac(1)] = '1'",,,,,,
o_pol_plac_result,pregnancy_loss,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 999, Unknown",,,,,,"[o_pol_plac(1)] = '1'",,,,,,
o_pol_cb,pregnancy_loss,,checkbox,"","1,",,,,,,"[o_pol] = '1'",,,,,,
o_pol_cb_col_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_cb(1)] = '1'",,,,,,
o_pol_cb_col_t,pregnancy_loss,,text,"",,,time,,,,"[o_pol_cb(1)] = '1'",,,,,,
o_pol_cb_rep_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_cb(1)] = '1'",,,,,,
o_pol_cb_test,pregnancy_loss,,text,"",,,,,,,"[o_pol_cb(1)] = '1'",,,,,,
o_pol_cb_result,pregnancy_loss,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 999, Unknown",,,,,,"[o_pol_cb(1)] = '1'",,,,,,
o_pol_fb,pregnancy_loss,,checkbox,"","1,",,,,,,"[o_pol] = '1'",,,,,,
o_pol_fb_col_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_fb(1)] = '1'",,,,,,
o_pol_fb_col_t,pregnancy_loss,,text,"",,,time,,,,"[o_pol_fb(1)] = '1'",,,,,,
o_pol_fb_rep_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_fb(1)] = '1'",,,,,,
o_pol_fb_test,pregnancy_loss,,text,"",,,,,,,"[o_pol_fb(1)] = '1'",,,,,,
o_pol_fb_result,pregnancy_loss,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 999, Unknown",,,,,,"[o_pol_fb(1)] = '1'",,,,,,
o_pol_fs,pregnancy_loss,,checkbox,"","1,",,,,,,"[o_pol] = '1'",,,,,,
o_pol_fs_col_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_fs(1)] = '1'",,,,,,
o_pol_fs_col_t,pregnancy_loss,,text,"",,,time,,,,"[o_pol_fs(1)] = '1'",,,,,,
o_pol_fs_rep_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_fs(1)] = '1'",,,,,,
o_pol_fs_test,pregnancy_loss,,text,"",,,,,,,"[o_pol_fs(1)] = '1'",,,,,,
o_pol_fs_result,pregnancy_loss,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 999, Unknown",,,,,,"[o_pol_fs(1)] = '1'",,,,,,
o_pol_oth,pregnancy_loss,,checkbox,"","1,",,,,,,"[o_pol] = '1'",,,,,,
o_pol_oth_s,pregnancy_loss,,text,"",,,,,,,"[o_pol_oth(1)] = '1'",,,,,,
o_pol_oth_col_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_oth(1)] = '1'",,,,,,
o_pol_oth_col_t,pregnancy_loss,,text,"",,,time,,,,"[o_pol_oth(1)] = '1'",,,,,,
o_pol_oth_rep_d,pregnancy_loss,,text,"",,,date_dmy,,,,"[o_pol_oth(1)] = '1'",,,,,,
o_pol_oth_test,pregnancy_loss,,text,"",,,,,,,"[o_pol_oth(1)] = '1'",,,,,,
o_pol_oth_result,pregnancy_loss,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 999, Unknown",,,,,,"[o_pol_oth(1)] = '1'",,,,,,
p_symptoms,delivery_information_maternal,,radio,"Symptoms intrapartum","0, No - asymptomatic | 1, Yes | 999, Unknown",,,,,,,,,,,,
p_fever,delivery_information_maternal,,radio,Fever,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_fever_temp,delivery_information_maternal,,radio,"","1, < 38°C | 2, 38-39C | 3, > 39°C | 999, Unknown",,,,,,"[p_fever] = '1'",,,,,,
p_cough,delivery_information_maternal,,radio,Cough,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_head,delivery_information_maternal,,radio,Headache,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_breath,delivery_information_maternal,,radio,"Shortness of breath","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_runny,delivery_information_maternal,,radio,"Runny nose","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_muscle,delivery_information_maternal,,radio,"Muscle pain/myalgia","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_anorexia,delivery_information_maternal,,radio,"Anorexia (loss of appetite)","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_diarrhea,delivery_information_maternal,,radio,Diarrhea,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_vomit,delivery_information_maternal,,radio,Vomiting,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_malaise,delivery_information_maternal,,radio,Malaise,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_fatigue,delivery_information_maternal,,radio,Fatigue,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_anosmia,delivery_information_maternal,,radio,"Anosmia or ageusia (loss of smell or taste)","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_throat,delivery_information_maternal,,radio,"Sore throat","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_sputum,delivery_information_maternal,,radio,"Sputum production","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_nausea,delivery_information_maternal,,radio,Nausea,"0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_resp,delivery_information_maternal,,radio,"Non-specific respiratory symptoms","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_othersx,delivery_information_maternal,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[p_symptoms] = '1'",,RH,,,,
p_othersx_spec,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_othersx] = '1'",,RH,,,,
p_othersx_2,delivery_information_maternal,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[p_othersx] = '1'",,RH,,,,
p_othersx_spec_2,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_othersx_2] = '1'",,RH,,,,
p_fetusno,delivery_information_maternal," ",radio,"Number of fetuses","1, 1 | 2, 2 | 3, 3+ | 999, Unknown",,,,,,,,RH,,,,
p_outcome,delivery_information_maternal,,radio,"Outcome of pregnancy","1, Pregnancy loss (< 20 weeks or < 500g) | 2, Stillbirth (>20 weeks or >500g) | 3, Live birth | 999, Unknown","*Note: If multiples with differing outcomes, contact coordinating centre",,,,,,,,,,,
p_desc,delivery_information_maternal,,descriptive,"Complete pregnancy loss form
",,,,,,,"[p_outcome] = '1' or [p_outcome] = '2'",,,,,,
p_labour,delivery_information_maternal,,checkbox,Labour,"1, No labour | 2, Spontaneous | 3, Induced | 999, Unknown",,,,,,,,,,,,
p_induced,delivery_information_maternal,,checkbox,"","1, Antepartum hemorrhage | 2, Chorioamnionitis | 3, Suspected fetal compromise | 4, Pre-labour rupture of membranes | 5, Postdates | 6, Autoimmune disease | 7, Intrauterine growth restriction | 8, Oligohydramnios | 9, COVID-19 | 998, Other | 999, Unknown",,,,,,"[p_labour(3)] = '1'",,,,,,
p_induced_s,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_induced(998)] = '1'",,,,,,
p_anes,delivery_information_maternal,,checkbox,"Type of anesthesia","0, None | 1, Spinal | 2, Epidural | 3, Entonox | 4, General-intubated | 999, Unknown | 998, Other",,,,,,,,,,,,
p_anes_s,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_anes(998)] = '1'",,,,,,
p_mode,delivery_information_maternal,,radio,Mode,"1, Vaginal | 2, C/S | 999, Unknown",,,,,,,,,,,,
p_cs_type,delivery_information_maternal,,radio,"","1, Elective | 2, Urgent | 3, Emergent | 999, Unknown",,,,,,"[p_mode] = '2'",,,,,,
p_cs_ind,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_mode] = '2'",,,,,,
p_rom_hh,delivery_information_maternal,,text,"Length of rupture of membrane - Hours",,"999 if unknown",number0-100,,,,,,,,,,
p_rom_mm,delivery_information_maternal,,text,"Length of rupture of membrane - Minutes",,"999 if unknown",number0-100,,,,,,,,,,
p_transfusion,delivery_information_maternal,"Delivery complications",radio,Transfusion,"0, No | 1, Yes | 999, Unknown",,,,,,,,,,o_complications,,
p_chorio,delivery_information_maternal,,radio,Chorioamnionitis,"0, No | 1, Yes | 999, Unknown",,,,,,,,,,o_complications,,
p_highesttemp,delivery_information_maternal,,text,"Highest temperature recorded (°C)
",,"999 if unknown",number_1dp,,,,,,,,,,
p_labfever,delivery_information_maternal,,radio,"Fever in labour (37.5°C+ or documented fever)
","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
p_labfever_highesttemp,delivery_information_maternal,,text,"If available, highest temperature recorded (°C)
",,"999 if unknown",number_1dp,,,,"[p_labfever] = '1'",,,,,,
p_labfever_reason,delivery_information_maternal,,checkbox,"Reason for fever in labour
","1, Asymptomatic fever (e.g. misoprostol) | 2, Symptomatic fever, OB related (chorioamnionitis, endometritis) | 3, Sepsis, OB related (chorioamnionitis, endometritis) | 4, COVID-related fever | 998, Other reason for fever | 999, Unknown",,,,,,"[p_labfever] = '1'",,,,,,
p_labfever_reason_s,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_labfever_reason(998)] = '1'",,,,,,
p_complications_oth,delivery_information_maternal,,radio,"Other delivery complications","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
p_complications_oth_s,delivery_information_maternal,,notes,"",,"999 if unknown",,,,,"[p_complications_oth] = '1'",,RH,,,,
p_cultures,delivery_information_maternal," ",radio,"Were cultures done for any reason?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
p_cultures_type1,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_cultures] = '1'",,RH,,,,
p_cultures_date1,delivery_information_maternal,,text,"",,,date_dmy,,,,"[p_cultures] = '1'",,RH,,,,
p_cultures_time1,delivery_information_maternal,,text,"",,,time,,,,"[p_cultures] = '1'",,RH,,,,
p_cultures_res1,delivery_information_maternal,,radio,"","0, Neg | 1, Pos | 999, Unknown",,,,,,"[p_cultures] = '1'",,RH,,,,
p_cultures_path1,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_cultures_res1] = '1'",,RH,,,,
p_cultures_add1,delivery_information_maternal,,checkbox,"","1,",,,,,,"[p_cultures] = '1'",,RH,,,,
p_cultures_type2,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_cultures_add1(1)] = '1'",,RH,,,,
p_cultures_date2,delivery_information_maternal,,text,"",,,date_dmy,,,,"[p_cultures_add1(1)] = '1'",,RH,,,,
p_cultures_time2,delivery_information_maternal,,text,"",,,time,,,,"[p_cultures_add1(1)] = '1'",,RH,,,,
p_cultures_res2,delivery_information_maternal,,radio,"","0, Neg | 1, Pos | 999, Unknown",,,,,,"[p_cultures_add1(1)] = '1'",,RH,,,,
p_cultures_path2,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_cultures_res2] = '1'",,RH,,,,
p_discharge,delivery_information_maternal," ",radio,"Maternal transfer / discharge","1, Transfer to postpartum ward then discharged home | 2, Transfer to different ward | 3, Maternal death | 4, Transfer to other organization | 5, Transfer to ICU / CCU | 999, Unknown",,,,,,,,LV,,,,
p_discharge_diffward,delivery_information_maternal,,text,"",,"999 if unknown",,,,,"[p_discharge] = '2'",,,,,,
p_matdeath_note,delivery_information_maternal,,descriptive,"Complete maternal death form",,,,,,,"[p_discharge] = '3'",,,,,,
p_transfericu_note,delivery_information_maternal,,descriptive,"Complete hospitalization form",,,,,,,"[p_discharge] = '5'",,,,,,
p_dischargedate,delivery_information_maternal,,text,"Maternal discharge date (if applicable)",,,date_dmy,,,,,,,,,,
p_comments,delivery_information_maternal," ",notes,"General comments",,,,,,,,,,,,,
q_desc,postpartum_medications_for_covid_intrapartum_throu,,descriptive,"NOTE: Record other medications on General Medications form
",,,,,,,,,,,,,
q_otc_none,postpartum_medications_for_covid_intrapartum_throu,"Over the counter medications",radio,,"0, No over the counter medications | 999, Unknown",,,,,,,,LH,,,,
q_otc,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"OTC meds","1,",,,,,,"[q_otc_none] = ''",,,,,,
q_otc_aceta,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_otc(1)] = '1'",,,,,,
q_otc_nsaids,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_otc(1)] = '1'",,,,,,
q_otc_nsaids_asp,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"Acetylsalicylic acid (Aspirin)
","1,",,,,,,"[q_otc_nsaids(1)] = '1'",,,,,,
q_otc_nsaids_ibu,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"Ibuprofen (Advil, Motrin, others)
","1,",,,,,,"[q_otc_nsaids(1)] = '1'",,,,,,
q_otc_nsaids_nap,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"Naproxen (Aleve, Naprosyn, other)
","1,",,,,,,"[q_otc_nsaids(1)] = '1'",,,,,,
q_otc_nsaids_oth,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_otc_nsaids(1)] = '1'",,,,,,
q_otc_nsaids_oth_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_otc_nsaids_oth(1)] = '1'",,,,,,
q_otc_nsaids_oth_2,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_otc_nsaids(1)] = '1'",,,,,,
q_otc_nsaids_oth_s_2,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_otc_nsaids_oth_2(1)] = '1'",,,,,,
q_otc_oth1,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_otc(1)] = '1'",,,,,,
q_otc_oth1_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_otc_oth1(1)] = '1'",,,,,,
q_otc_oth2,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_otc(1)] = '1' and [q_otc_oth1(1)] = '1'",,,,,,
q_otc_oth2_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_otc_oth2(1)] = '1'",,,,,,
q_otc_oth3,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_otc(1)] = '1' and [q_otc_oth2(1)] = '1'",,,,,,
q_otc_oth3_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_otc_oth3(1)] = '1'",,,,,,
q_pres_none,postpartum_medications_for_covid_intrapartum_throu,"Prescription medications",radio,,"0, No prescription medications | 999, Unknown",,,,,,,,LH,,,,
q_pres_cort,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"Corticosteroids (check all taken)
","1,",,,,,,"[q_pres_none] = ''",,,,,,
q_pres_cort_dex,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_cort(1)] = '1'",,,,,,
q_pres_cort_dex_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_cort_dex(1)] = '1'",,,,,,
q_pres_cort_dex_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_dex(1)] = '1'",,,,,,
q_pres_cort_dex_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_dex(1)] = '1'",,,,,,
q_pres_cort_oth,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_cort(1)] = '1'",,,,,,
q_pres_cort_oth_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_oth(1)] = '1'",,,,,,
q_pres_cort_oth_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_cort_oth(1)] = '1'",,,,,,
q_pres_cort_oth_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_oth(1)] = '1'",,,,,,
q_pres_cort_oth_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_oth(1)] = '1'",,,,,,
q_pres_cort_oth_2,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_cort_oth(1)] = '1'",,,,,,
q_pres_cort_oth_s_2,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_oth_2(1)] = '1'",,,,,,
q_pres_cort_oth_ct_2,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_cort_oth_2(1)] = '1'",,,,,,
q_pres_cort_oth_dose_2,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_oth_2(1)] = '1'",,,,,,
q_pres_cort_oth_dur_2,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_cort_oth_2(1)] = '1'",,,,,,
q_pres_chlor,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_none] = ''",,,,,,
q_pres_chlor_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_chlor(1)] = '1'",,,,,,
q_pres_chlor_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_chlor(1)] = '1'",,,,,,
q_pres_chlor_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_chlor(1)] = '1'",,,,,,
q_pres_chlor_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_chlor(1)] = '1'",,,,,,
q_pres_hydrox,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_none] = ''",,,,,,
q_pres_hydrox_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_hydrox(1)] = '1'",,,,,,
q_pres_hydrox_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_hydrox(1)] = '1'",,,,,,
q_pres_hydrox_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_hydrox(1)] = '1'",,,,,,
q_pres_hydrox_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_hydrox(1)] = '1'",,,,,,
q_pres_colch,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_none] = ''",,,,,,
q_pres_colch_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_colch(1)] = '1'",,,,,,
q_pres_colch_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_colch(1)] = '1'",,,,,,
q_pres_colch_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_colch(1)] = '1'",,,,,,
q_pres_av,postpartum_medications_for_covid_intrapartum_throu,,checkbox," Antiviral (check all taken)
","1,",,,,,,"[q_pres_none] = ''",,,,,,
q_pres_av_kal,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"Kaletra (Lopinavir/Ritonavir)
","1,",,,,,,"[q_pres_av(1)] = '1'",,,,,,
q_pres_av_kal_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_av_kal(1)] = '1'",,,,,,
q_pres_av_kal_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_kal(1)] = '1'",,,,,,
q_pres_av_kal_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_kal(1)] = '1'",,,,,,
q_pres_av_rem,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_av(1)] = '1'",,,,,,
q_pres_av_rem_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_av_rem(1)] = '1'",,,,,,
q_pres_av_rem_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_rem(1)] = '1'",,,,,,
q_pres_av_rem_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_rem(1)] = '1'",,,,,,
q_pres_av_oth1,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_av(1)] = '1'",,,,,,
q_pres_av_oth1_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_oth1(1)] = '1'",,,,,,
q_pres_av_oth1_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_av_oth1(1)] = '1'",,,,,,
q_pres_av_oth1_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_oth1(1)] = '1'",,,,,,
q_pres_av_oth1_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_oth1(1)] = '1'",,,,,,
q_pres_av_oth2,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_av_oth1(1)] = '1'",,,,,,
q_pres_av_oth2_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_oth2(1)] = '1'",,,,,,
q_pres_av_oth2_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_av_oth2(1)] = '1'",,,,,,
q_pres_av_oth2_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_oth2(1)] = '1'",,,,,,
q_pres_av_oth2_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_av_oth2(1)] = '1'",,,,,,
q_pres_ab,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"Antibiotics (check all taken)
","1,",,,,,,"[q_pres_none] = ''",,,,,,
q_pres_ab_s1,postpartum_medications_for_covid_intrapartum_throu,,text,"",,,,,,,"[q_pres_ab(1)] = '1'",,,,,,
q_pres_ab_1_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_ab_s1] <> ''",,,,,,
q_pres_ab_1_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_ab_s1] <> ''",,,,,,
q_pres_ab_1_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_ab_s1] <> ''",,,,,,
q_pres_ab_s2,postpartum_medications_for_covid_intrapartum_throu,,text,"",,,,,,,"[q_pres_ab_s1] <> ''",,,,,,
q_pres_ab_2_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_ab_s2] <> ''",,,,,,
q_pres_ab_2_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_ab_s2] <> ''",,,,,,
q_pres_ab_2_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_ab_s2] <> ''",,,,,,
q_pres_oth1,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_none] = ''",,,,,,
q_pres_oth1_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth1(1)] = '1'",,,,,,
q_pres_oth1_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth1(1)] = '1'",,,,,,
q_pres_oth1_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth1(1)] = '1'",,,,,,
q_pres_oth1_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth1(1)] = '1'",,,,,,
q_pres_oth2,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth1(1)] = '1'",,,,,,
q_pres_oth2_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth2(1)] = '1'",,,,,,
q_pres_oth2_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth2(1)] = '1'",,,,,,
q_pres_oth2_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth2(1)] = '1'",,,,,,
q_pres_oth2_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth2(1)] = '1'",,,,,,
q_pres_oth3,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth2(1)] = '1'",,,,,,
q_pres_oth3_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth3(1)] = '1'",,,,,,
q_pres_oth3_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth3(1)] = '1'",,,,,,
q_pres_oth3_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth3(1)] = '1'",,,,,,
q_pres_oth3_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth3(1)] = '1'",,,,,,
q_pres_oth4,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth3(1)] = '1'",,,,,,
q_pres_oth4_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth4(1)] = '1'",,,,,,
q_pres_oth4_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth4(1)] = '1'",,,,,,
q_pres_oth4_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth4(1)] = '1'",,,,,,
q_pres_oth4_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth4(1)] = '1'",,,,,,
q_pres_oth5,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth4(1)] = '1'",,,,,,
q_pres_oth5_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth5(1)] = '1'",,,,,,
q_pres_oth5_ct,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"","1,",,,,,,"[q_pres_oth5(1)] = '1'",,,,,,
q_pres_oth5_dose,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth5(1)] = '1'",,,,,,
q_pres_oth5_dur,postpartum_medications_for_covid_intrapartum_throu,,text,"",,"999 if unknown",,,,,"[q_pres_oth5(1)] = '1'",,,,,,
q_nat_none,postpartum_medications_for_covid_intrapartum_throu,"Natural Health Products",radio,,"0, No natural health products | 999, Unknown",,,,,,,,LH,,,,
q_nat,postpartum_medications_for_covid_intrapartum_throu,,checkbox,"Natural health products","1,",,,,,,"[q_nat_none] = ''",,,,,,
q_nat1_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,,,,,,"[q_nat(1)] = '1'",,,,,,
q_nat2_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,,,,,,"[q_nat1_s] <> ''",,,,,,
q_nat3_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,,,,,,"[q_nat2_s] <> ''",,,,,,
q_nat4_s,postpartum_medications_for_covid_intrapartum_throu,,text,"",,,,,,,"[q_nat3_s] <> ''",,,,,,
r_num,infant_delivery_through_discharge_a,,radio,,"1, Singleton | 2, Twin | 998, Other",,,,,,,,LH,,,,
r_num_s,infant_delivery_through_discharge_a,,text,"",,"999 if unknown",,,,,"[r_num] = '998'",,,,,,
r_baby,infant_delivery_through_discharge_a,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
r_dob,infant_delivery_through_discharge_a,,text,"Date of birth",,,date_dmy,,,,,,,,,,
r_tob,infant_delivery_through_discharge_a,,text,"Time of birth",,,time,,,,,,,,,,
r_birthplace,infant_delivery_through_discharge_a,,radio,"Place of birth","1, Hospital | 2, Home | 998, Other | 999, Unknown",,,,,,,,,,,,
r_birthplace_hosp,infant_delivery_through_discharge_a,,text,"",,"999 if unknown",,,,y,"[r_birthplace] = '1'",,,,,,
r_birthplace_other,infant_delivery_through_discharge_a,,text,"",,"999 if unknown",,,,,"[r_birthplace] = '998'",,,,,,
r_iaotrogenic,infant_delivery_through_discharge_a,,radio,"Iatrogenic preterm birth?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_spontaneous,infant_delivery_through_discharge_a,,radio,"Spontaneous preterm birth?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_umbcord,infant_delivery_through_discharge_a,,text,"Umbilical cord pH (arterial)",,"999 if unknown",number_2dp,,,,,,RH,,,,
r_baseexcess,infant_delivery_through_discharge_a,,text,"Base excess",,"999 if unknown",number_2dp,,,,,,RH,,,,
r_discharge,infant_delivery_through_discharge_a,,text,"Discharge date of infant",,"If not admmitted to NICU for symptoms or different from maternal discharge date",date_dmy,,,,,,,,,,
r_path,infant_delivery_through_discharge_a,"Placenta testing",radio,"Placental pathology, including cytogenetics done?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_path_res,infant_delivery_through_discharge_a,,radio,"","1, Normal | 2, Abnormal | 999, Unknown",,,,,,"[r_path] = '1'",,RH,,,,
r_path_res_desc,infant_delivery_through_discharge_a,,notes,"",,"999 if unknown",,,,,"[r_path] = '1'",,RH,,,,
r_covtest,infant_delivery_through_discharge_a,,radio,"Was placenta testing for SARS-COV-2 done? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_covtest_collect_d,infant_delivery_through_discharge_a,,text,"",,,date_dmy,,,,"[r_covtest] = '1'",,RH,,,,
r_covtest_collect_t,infant_delivery_through_discharge_a,,text,"",,,time,,,,"[r_covtest] = '1'",,RH,,,,
r_covtest_lab,infant_delivery_through_discharge_a,,text,"",,,date_dmy,,,,"[r_covtest] = '1'",,RH,,,,
r_covtest_test,infant_delivery_through_discharge_a,,text,"",,"999 if unknown",,,,,"[r_covtest] = '1'",,RH,,,,
r_cov_res,infant_delivery_through_discharge_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[r_covtest] = '1'",,,,,,
r_comments,infant_delivery_through_discharge_a," ",notes,"General comments",,,,,,,,,,,,,
r_baby_2,infant_delivery_through_discharge_b,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
r_dob_2,infant_delivery_through_discharge_b,,text,"Date of birth",,,date_dmy,,,,,,,,,,
r_tob_2,infant_delivery_through_discharge_b,,text,"Time of birth",,,time,,,,,,,,,,
r_birthplace_2,infant_delivery_through_discharge_b,,radio,"Place of birth","1, Hospital | 2, Home | 998, Other | 999, Unknown",,,,,,,,,,,,
r_birthplace_hosp_2,infant_delivery_through_discharge_b,,text,"",,"999 if unknown",,,,y,"[r_birthplace_2] = '1'",,,,,,
r_birthplace_other_2,infant_delivery_through_discharge_b,,text,"",,"999 if unknown",,,,,"[r_birthplace_2] = '998'",,,,,,
r_iaotrogenic_2,infant_delivery_through_discharge_b,,radio,"Iatrogenic preterm birth?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_spontaneous_2,infant_delivery_through_discharge_b,,radio,"Spontaneous preterm birth?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_umbcord_2,infant_delivery_through_discharge_b,,text,"Umbilical cord pH (arterial)",,"999 if unknown",number_2dp,,,,,,RH,,,,
r_baseexcess_2,infant_delivery_through_discharge_b,,text,"Base excess",,"999 if unknown",number_2dp,,,,,,RH,,,,
r_discharge_2,infant_delivery_through_discharge_b,,text,"Discharge date of infant",,"If not admmitted to NICU for symptoms or different from maternal discharge date",date_dmy,,,,,,,,,,
r_path_2,infant_delivery_through_discharge_b,"Placenta testing",radio,"Placental pathology, including cytogenetics done?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_path_res_2,infant_delivery_through_discharge_b,,radio,"","1, Normal | 2, Abnormal | 999, Unknown",,,,,,"[r_path_2] = '1'",,RH,,,,
r_path_res_desc_2,infant_delivery_through_discharge_b,,notes,"",,"999 if unknown",,,,,"[r_path_2] = '1'",,RH,,,,
r_covtest_2,infant_delivery_through_discharge_b,,radio,"Was placenta testing for SARS-COV-2 done? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_covtest_collect_d_2,infant_delivery_through_discharge_b,,text,"",,,date_dmy,,,,"[r_covtest_2] = '1'",,RH,,,,
r_covtest_collect_t_2,infant_delivery_through_discharge_b,,text,"",,,time,,,,"[r_covtest_2] = '1'",,RH,,,,
r_covtest_lab_2,infant_delivery_through_discharge_b,,text,"",,,date_dmy,,,,"[r_covtest_2] = '1'",,RH,,,,
r_covtest_test_2,infant_delivery_through_discharge_b,,text,"",,"999 if unknown",,,,,"[r_covtest_2] = '1'",,RH,,,,
r_cov_res_2,infant_delivery_through_discharge_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[r_covtest_2] = '1'",,,,,,
r_comments_2,infant_delivery_through_discharge_b," ",notes,"General comments",,,,,,,,,,,,,
r_baby_3,infant_delivery_through_discharge_c,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
r_dob_3,infant_delivery_through_discharge_c,,text,"Date of birth",,,date_dmy,,,,,,,,,,
r_tob_3,infant_delivery_through_discharge_c,,text,"Time of birth",,,time,,,,,,,,,,
r_birthplace_3,infant_delivery_through_discharge_c,,radio,"Place of birth","1, Hospital | 2, Home | 998, Other | 999, Unknown",,,,,,,,,,,,
r_birthplace_hosp_3,infant_delivery_through_discharge_c,,text,"",,"999 if unknown",,,,y,"[r_birthplace_3] = '1'",,,,,,
r_birthplace_other_3,infant_delivery_through_discharge_c,,text,"",,"999 if unknown",,,,,"[r_birthplace_3] = '998'",,,,,,
r_iaotrogenic_3,infant_delivery_through_discharge_c,,radio,"Iatrogenic preterm birth?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_spontaneous_3,infant_delivery_through_discharge_c,,radio,"Spontaneous preterm birth?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_umbcord_3,infant_delivery_through_discharge_c,,text,"Umbilical cord pH (arterial)",,"999 if unknown",number_2dp,,,,,,RH,,,,
r_baseexcess_3,infant_delivery_through_discharge_c,,text,"Base excess",,"999 if unknown",number_2dp,,,,,,RH,,,,
r_discharge_3,infant_delivery_through_discharge_c,,text,"Discharge date of infant",,"If not admmitted to NICU for symptoms or different from maternal discharge date",date_dmy,,,,,,,,,,
r_path_3,infant_delivery_through_discharge_c,"Placenta testing",radio,"Placental pathology, including cytogenetics done?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_path_res_3,infant_delivery_through_discharge_c,,radio,"","1, Normal | 2, Abnormal | 999, Unknown",,,,,,"[r_path_3] = '1'",,RH,,,,
r_path_res_desc_3,infant_delivery_through_discharge_c,,notes,"",,"999 if unknown",,,,,"[r_path_3] = '1'",,RH,,,,
r_covtest_3,infant_delivery_through_discharge_c,,radio,"Was placenta testing for SARS-COV-2 done? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
r_covtest_collect_d_3,infant_delivery_through_discharge_c,,text,"",,,date_dmy,,,,"[r_covtest_3] = '1'",,RH,,,,
r_covtest_collect_t_3,infant_delivery_through_discharge_c,,text,"",,,time,,,,"[r_covtest_3] = '1'",,RH,,,,
r_covtest_lab_3,infant_delivery_through_discharge_c,,text,"",,,date_dmy,,,,"[r_covtest_3] = '1'",,RH,,,,
r_covtest_test_3,infant_delivery_through_discharge_c,,text,"",,"999 if unknown",,,,,"[r_covtest_3] = '1'",,RH,,,,
r_cov_res_3,infant_delivery_through_discharge_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[r_covtest_3] = '1'",,,,,,
r_comments_3,infant_delivery_through_discharge_c," ",notes,"General comments",,,,,,,,,,,,,
s_baby,delivery_room_management_a,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
s_apgar_1,delivery_room_management_a,APGARs,text,"",,"999 if unknown",,,,,,,,,,,
s_apgar_5,delivery_room_management_a,,text,"",,"999 if unknown",,,,,,,,,,,
s_apgar_10,delivery_room_management_a,,text,"",,"999 if unknown",,,,,"[s_apgar_10_notdone(1)] = ''",,,,,,
s_apgar_10_notdone,delivery_room_management_a,,checkbox,"","1,",,,,,,,,,,,,
s_resus_any,delivery_room_management_a,,radio,"Any oxygen & resuscitation needs?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
s_freeflow,delivery_room_management_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any] = '1'",,RH,,,,
s_freeflow_desc,delivery_room_management_a,,text,"",,,,,,,"[s_freeflow] = '1'",,RH,,,,
s_ippv,delivery_room_management_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any] = '1'",,RH,,,,
s_ippv_desc,delivery_room_management_a,,text,"",,,,,,,"[s_ippv] = '1'",,RH,,,,
s_intubation,delivery_room_management_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any] = '1'",,RH,,,,
s_intubation_desc,delivery_room_management_a,,text,"",,,,,,,"[s_intubation] = '1'",,RH,,,,
s_cpap,delivery_room_management_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any] = '1'",,RH,,,,
s_cpap_desc,delivery_room_management_a,,text,"",,,,,,,"[s_cpap] = '1'",,RH,,,,
s_cpr,delivery_room_management_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any] = '1'",,RH,,,,
s_cpr_desc,delivery_room_management_a,,text,"",,,,,,,"[s_cpr] = '1'",,RH,,,,
s_resus_oth,delivery_room_management_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any] = '1'",,RH,,,,
s_resus_oth_des,delivery_room_management_a,,text,"",,,,,,,"[s_resus_oth] = '1'",,RH,,,,
s_bw_units,delivery_room_management_a," ",radio,"","1, lbs+oz | 2, gm | 999, Unknown",,,,,,,,RH,,,,
s_bw_lb,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_bw_units] = '1'",,RH,,,,
s_bw_oz,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_bw_units] = '1'",,RH,,,,
s_bw_gm,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_bw_units] = '2'",,RH,,,,
s_len_units,delivery_room_management_a,,radio,"Birth length","1, in | 2, cm | 999, Unknown",,,,,,,,RH,,,,
s_len_in,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_len_units] = '1'",,RH,,,,
s_len_cm,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_len_units] = '2'",,RH,,,,
s_circ_units,delivery_room_management_a,,radio,"Birth head circ","1, in | 2, cm | 999, Unknown",,,,,,,,RH,,,,
s_circ_in,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_circ_units] = '1'",,RH,,,,
s_circ_cm,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_circ_units] = '2'",,RH,,,,
s_delayedcc,delivery_room_management_a,,radio,"Delayed cord clamping","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_delayedcc_dur,delivery_room_management_a,,text,"If yes, duration (seconds)
",,"999 if unknown",number,,,,"[s_delayedcc] = '1'",,RH,,,,
s_pe_date,delivery_room_management_a,"Initial physical examination",text,"Date (leave empty if done at birth)",,,date_dmy,,,,,,RH,,,,
s_pe_time,delivery_room_management_a,,text,"Time (leave empty if done at birth)",,,time,,,,,,RH,,,,
s_pe_resp,delivery_room_management_a,,radio,"Respiratory exam","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_resp_ab,delivery_room_management_a,,radio,"","1, Tachypnea | 2, Dyspnea | 3, Cyanosis",,,,,,"[s_pe_resp] = '2'",,RH,,,,
s_pe_cv,delivery_room_management_a,,radio,"Cardiovascular system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_cv_ab,delivery_room_management_a,,radio,"","1, Poorly perfused | 2, Heart murmur | 3, Cyanosis",,,,,,"[s_pe_cv] = '2'",,RH,,,,
s_pe_abdo,delivery_room_management_a,,radio,"Abdominal system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_abdo_ab,delivery_room_management_a,,radio,"","1, Hepatomegaly | 2, Splenomegaly",,,,,,"[s_pe_abdo] = '2'",,RH,,,,
s_pe_neuro,delivery_room_management_a,,radio,"Neurological system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_neuro_ab,delivery_room_management_a,,radio,"","1, Tone | 2, Tendon reflexes | 3, Power",,,,,,"[s_pe_neuro] = '2'",,RH,,,,
s_pe_genitalia,delivery_room_management_a,,radio,Genitalia,"1, Male | 2, Female | 3, Ambiguous",,,,,,,,RH,,,,
s_pe_dysmorph,delivery_room_management_a,,radio,Dysmorphism,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_pe_dysmorph_desc,delivery_room_management_a,,notes,"",,"999 if unknown",,,,,"[s_pe_dysmorph] = '1'",,RH,,,,
s_pe_other,delivery_room_management_a,,radio,"Any other significant findings? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_pe_other_desc,delivery_room_management_a,,notes,"",,"999 if unknown",,,,,"[s_pe_other] = '1'",,RH,,,,
s_id,delivery_room_management_a," ",radio,"Screening for other infectious diseases? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_id_spec1,delivery_room_management_a,,text,"",,"999 if unknown",,,,,"[s_id] = '1'",,RH,,,,
s_id_date1,delivery_room_management_a,,text,"",,,date_dmy,,,,"[s_id] = '1'",,RH,,,,
s_id_pos1,delivery_room_management_a,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id] = '1'",,,,,,
s_id_add1,delivery_room_management_a,,checkbox,"","1,",,,,,,"[s_id] = '1'",,RH,,,,
s_id_spec2,delivery_room_management_a,,text,"",,,,,,,"[s_id_add1(1)] = '1'",,RH,,,,
s_id_date2,delivery_room_management_a,,text,"",,,date_dmy,,,,"[s_id_add1(1)] = '1'",,RH,,,,
s_id_pos2,delivery_room_management_a,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_add1(1)] = '1'",,,,,,
s_id_add2,delivery_room_management_a,,checkbox,"","1,",,,,,,"[s_id_add1(1)] = '1'",,RH,,,,
s_id_spec3,delivery_room_management_a,,text,"",,,,,,,"[s_id_add2(1)] = '1'",,RH,,,,
s_id_date3,delivery_room_management_a,,text,"",,,date_dmy,,,,"[s_id_add2(1)] = '1'",,RH,,,,
s_id_pos3,delivery_room_management_a,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_add2(1)] = '1'",,,,,,
s_bc,delivery_room_management_a," ",radio,"Blood count","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_bc_date,delivery_room_management_a,,text,"",,,date_dmy,,,,"[s_bc] = '1'",,RH,,,,
s_bc_time,delivery_room_management_a,,text,"",,,time,,,,"[s_bc] = '1'",,RH,,,,
s_bc_res,delivery_room_management_a,,radio,"","1, Positive/abnormal | 2, Negative/normal | 999, Unknown",,,,,,"[s_bc] = '1'",,,,,,
s_bc_rep_s,delivery_room_management_a,,text,"",,"999 if unknown",,,,,"[s_bc_res] = '1'",,RH,,,,
s_othinv,delivery_room_management_a," ",radio,"Other investigations?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othinv_spec1,delivery_room_management_a,,text,"",,,,,,,"[s_othinv] = '1'",,RH,,,,
s_othinv_date1,delivery_room_management_a,,text,"",,,date_dmy,,,,"[s_othinv] = '1'",,RH,,,,
s_othinv_pos1,delivery_room_management_a,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv] = '1'",,,,,,
s_othinv_add1,delivery_room_management_a,,checkbox,"","1,",,,,,,"[s_othinv] = '1'",,RH,,,,
s_othinv_spec2,delivery_room_management_a,,text,"",,,,,,,"[s_othinv_add1(1)] = '1'",,RH,,,,
s_othinv_date2,delivery_room_management_a,,text,"",,,date_dmy,,,,"[s_othinv_add1(1)] = '1'",,RH,,,,
s_othinv_pos2,delivery_room_management_a,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_add1(1)] = '1'",,,,,,
s_othinv_add2,delivery_room_management_a,,checkbox,"","1,",,,,,,"[s_othinv_add1(1)] = '1'",,RH,,,,
s_othinv_spec3,delivery_room_management_a,,text,"",,,,,,,"[s_othinv_add2(1)] = '1'",,RH,,,,
s_othinv_date3,delivery_room_management_a,,text,"",,,date_dmy,,,,"[s_othinv_add2(1)] = '1'",,RH,,,,
s_othinv_pos3,delivery_room_management_a,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_add2(1)] = '1'",,,,,,
s_healthevents,delivery_room_management_a," ",radio,"Any infant health events / issues between birth and discharge","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
s_jaundice,delivery_room_management_a,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents] = '1'",,RH,,,,
s_jaundice_des,delivery_room_management_a,,text,"",,,,,,,"[s_jaundice] = '1'",,RH,,,,
s_jaundice_photo,delivery_room_management_a,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_jaundice] = '1'",,RH,,,,
s_seizures,delivery_room_management_a,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents] = '1'",,RH,,,,
s_seizures_des,delivery_room_management_a,,text,"",,,,,,,"[s_seizures] = '1'",,RH,,,,
s_hypoglycemia,delivery_room_management_a,,radio,"Hypoglycemia (glucometer < 2.6mmol/L)
","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents] = '1'",,RH,,,,
s_hypoglycemia_des,delivery_room_management_a,,text,"",,,,,,,"[s_hypoglycemia] = '1'",,RH,,,,
s_infdeath,delivery_room_management_a,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents] = '1'",,RH,,,,
s_infdeath_desc,delivery_room_management_a,,descriptive,"Please complete infant death form
",,,,,,,"[s_infdeath] = '1'",,,,,,
s_nicu,delivery_room_management_a,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents] = '1'",,RH,,,,
s_nicu_desc,delivery_room_management_a,,descriptive,"Complete NICU form, including all diagnoses in NICU
",,,,,,,"[s_nicu] = '1'",,,,,,
s_otherissues,delivery_room_management_a,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents] = '1'",,RH,,,,
s_otherissues_des,delivery_room_management_a,,text,"",,"999 if unknown",,,,,"[s_otherissues] = '1'",,RH,,,,
s_manage_desc,delivery_room_management_a," ",descriptive,"NOTE: If mother and baby are both doing well/asymptomatic (e.g. if mother has recovered from COVID), select option A for mother, and leave three sub-options related to baby blank/unselected, as not applicable.
",,,,,,,,,,,,,
s_manage,delivery_room_management_a,,radio,"Infant management:","1, A) Mother asymptomatic or mild symptoms: able to do self care out of hospital/ not hospitalized for COVID | 2, B) Mother symptomatic requires ongoing hospitalization for management of COVID, but not critical care | 3, C) Mother in critical care for COVID | 999, D) Unknown | 998, E) Other",,,,,,,,LV,,,,
s_manage_oth,delivery_room_management_a,,text,"",,,,,,,"[s_manage] = '998'",,,,,,
s_manage_asym,delivery_room_management_a,,radio,,"1, Baby in joint isolation with mother in postpartum: with skin-to-skin contact and/or breastfeeding | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage] = '1'",,LV,,,,
s_manage_sym,delivery_room_management_a,,radio,,"1, Baby in joint isolation with mother in postpartum: with skin-to-skin contact and/or breastfeeding | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage] = '2'",,LV,,,,
s_manage_crit,delivery_room_management_a,,radio,,"1, Baby allowed close contact with mum - skin to skin contact or within 2 m | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage] = '3'",,LV,,,,
s_manage_iso_days,delivery_room_management_a,,text,"",,"999 if unknown",number,,,,"[s_manage_asym] = '2' or [s_manage_sym] = '2' or [s_manage_crit] = '2'",,,,,,
s_manage_iso_loc,delivery_room_management_a,,radio,"Location of baby isolation
","1, Postpartum ward | 2, Special Care Nursery | 998, Other","999 if unknown",,,,,"[s_manage_asym] = '2' or [s_manage_sym] = '2' or [s_manage_crit] = '2'",,,,,,
s_manage_iso_loc_oth,delivery_room_management_a,,text,"",,"999 if unknown",,,,,"[s_manage_iso_loc] = '998'",,,,,,
s_bf,delivery_room_management_a," ",radio,"Was breast feeding started right after birth? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_bf_when,delivery_room_management_a,,text,"If not, at which day of life was breast feeding started?
",,"days of life; 999 if unknown",number,,,,"[s_bf] = '0' and [s_bf_never(1)] = '0'",,RH,,,,
s_bf_never,delivery_room_management_a,,checkbox,"Not started prior to dischargeÂ
","1,",,,,,,"[s_bf] = '0' and [s_bf_when] = ''",,RH,,,,
s_bf_delay,delivery_room_management_a,,radio,"Was breastfeeding delayed because COVID+ or suspected COVID+? Â
","0, No | 1, Yes | 999, Unknown",,,,,,"[s_bf] = '0'",,RH,,,,
s_feed_bf,delivery_room_management_a,"Type of feeding through first 48 hours",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
s_feed_express,delivery_room_management_a,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed,,
s_feed_form,delivery_room_management_a,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed,,
s_feed_donor,delivery_room_management_a,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed,,
s_feed_iv,delivery_room_management_a,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed,,
s_meds_desc,delivery_room_management_a," Infant medications",descriptive,"Medications given to infant (not including those administered in NICU, complete NICU information form)",,,,,,,,,,,,,
s_erythro,delivery_room_management_a,,radio,"Erythromycin (eye prophylaxis)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_vitk,delivery_room_management_a,,radio,"Vitamin K","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othermeds,delivery_room_management_a,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othermeds_s1,delivery_room_management_a,,text,"",,,,,,,"[s_othermeds] = '1'",,RH,,,,
s_othermeds_ind1,delivery_room_management_a,,text,"",,,,,,,"[s_othermeds] = '1'",,RH,,,,
s_othermeds_add1,delivery_room_management_a,,checkbox,"","1,",,,,,,"[s_othermeds] = '1'",,RH,,,,
s_othermeds_s2,delivery_room_management_a,,text,"",,,,,,,"[s_othermeds_add1(1)] = '1'",,RH,,,,
s_othermeds_ind2,delivery_room_management_a,,text,"",,,,,,,"[s_othermeds_add1(1)] = '1'",,RH,,,,
s_othermeds_add2,delivery_room_management_a,,checkbox,"","1,",,,,,,"[s_othermeds_add1(1)] = '1'",,RH,,,,
s_othermeds_s3,delivery_room_management_a,,text,"",,,,,,,"[s_othermeds_add2(1)] = '1'",,RH,,,,
s_othermeds_ind3,delivery_room_management_a,,text,"",,,,,,,"[s_othermeds_add2(1)] = '1'",,RH,,,,
s_comments,delivery_room_management_a,,notes,"General comments",,,,,,,,,,,,,
s_baby_2,delivery_room_management_b,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
s_apgar_1_2,delivery_room_management_b,APGARs,text,"",,"999 if unknown",,,,,,,,,,,
s_apgar_5_2,delivery_room_management_b,,text,"",,"999 if unknown",,,,,,,,,,,
s_apgar_10_2,delivery_room_management_b,,text,"",,"999 if unknown",,,,,"[s_apgar_10_notdone_2(1)] = ''",,,,,,
s_apgar_10_notdone_2,delivery_room_management_b,,checkbox,"","1,",,,,,,,,,,,,
s_resus_any_2,delivery_room_management_b,,radio,"Any oxygen & resuscitation needs?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
s_freeflow_2,delivery_room_management_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_2] = '1'",,RH,,,,
s_freeflow_desc_2,delivery_room_management_b,,text,"",,,,,,,"[s_freeflow_2] = '1'",,RH,,,,
s_ippv_2,delivery_room_management_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_2] = '1'",,RH,,,,
s_ippv_desc_2,delivery_room_management_b,,text,"",,,,,,,"[s_ippv_2] = '1'",,RH,,,,
s_intubation_2,delivery_room_management_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_2] = '1'",,RH,,,,
s_intubation_desc_2,delivery_room_management_b,,text,"",,,,,,,"[s_intubation_2] = '1'",,RH,,,,
s_cpap_2,delivery_room_management_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_2] = '1'",,RH,,,,
s_cpap_desc_2,delivery_room_management_b,,text,"",,,,,,,"[s_cpap_2] = '1'",,RH,,,,
s_cpr_2,delivery_room_management_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_2] = '1'",,RH,,,,
s_cpr_desc_2,delivery_room_management_b,,text,"",,,,,,,"[s_cpr_2] = '1'",,RH,,,,
s_resus_oth_2,delivery_room_management_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_2] = '1'",,RH,,,,
s_resus_oth_des_2,delivery_room_management_b,,text,"",,,,,,,"[s_resus_oth_2] = '1'",,RH,,,,
s_bw_units_2,delivery_room_management_b," ",radio,"","1, lbs+oz | 2, gm | 999, Unknown",,,,,,,,RH,,,,
s_bw_lb_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_bw_units_2] = '1'",,RH,,,,
s_bw_oz_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_bw_units_2] = '1'",,RH,,,,
s_bw_gm_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_bw_units_2] = '2'",,RH,,,,
s_len_units_2,delivery_room_management_b,,radio,"Birth length","1, in | 2, cm | 999, Unknown",,,,,,,,RH,,,,
s_len_in_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_len_units_2] = '1'",,RH,,,,
s_len_cm_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_len_units_2] = '2'",,RH,,,,
s_circ_units_2,delivery_room_management_b,,radio,"Birth head circ","1, in | 2, cm | 999, Unknown",,,,,,,,RH,,,,
s_circ_in_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_circ_units_2] = '1'",,RH,,,,
s_circ_cm_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_circ_units_2] = '2'",,RH,,,,
s_delayedcc_2,delivery_room_management_b,,radio,"Delayed cord clamping","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_delayedcc_dur_2,delivery_room_management_b,,text,"If yes, duration (seconds)
",,"999 if unknown",number,,,,"[s_delayedcc_2] = '1'",,RH,,,,
s_pe_date_2,delivery_room_management_b,"Initial physical examination",text,"Date (leave empty if done at birth)",,,date_dmy,,,,,,RH,,,,
s_pe_time_2,delivery_room_management_b,,text,"Time (leave empty if done at birth)",,,time,,,,,,RH,,,,
s_pe_resp_2,delivery_room_management_b,,radio,"Respiratory exam","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_resp_ab_2,delivery_room_management_b,,radio,"","1, Tachypnea | 2, Dyspnea | 3, Cyanosis",,,,,,"[s_pe_resp_2] = '2'",,RH,,,,
s_pe_cv_2,delivery_room_management_b,,radio,"Cardiovascular system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_cv_ab_2,delivery_room_management_b,,radio,"","1, Poorly perfused | 2, Heart murmur | 3, Cyanosis",,,,,,"[s_pe_cv_2] = '2'",,RH,,,,
s_pe_abdo_2,delivery_room_management_b,,radio,"Abdominal system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_abdo_ab_2,delivery_room_management_b,,radio,"","1, Hepatomegaly | 2, Splenomegaly",,,,,,"[s_pe_abdo_2] = '2'",,RH,,,,
s_pe_neuro_2,delivery_room_management_b,,radio,"Neurological system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_neuro_ab_2,delivery_room_management_b,,radio,"","1, Tone | 2, Tendon reflexes | 3, Power",,,,,,"[s_pe_neuro_2] = '2'",,RH,,,,
s_pe_genitalia_2,delivery_room_management_b,,radio,Genitalia,"1, Male | 2, Female | 3, Ambiguous",,,,,,,,RH,,,,
s_pe_dysmorph_2,delivery_room_management_b,,radio,Dysmorphism,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_pe_dysmorph_desc_2,delivery_room_management_b,,notes,"",,"999 if unknown",,,,,"[s_pe_dysmorph_2] = '1'",,RH,,,,
s_pe_other_2,delivery_room_management_b,,radio,"Any other significant findings? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_pe_other_desc_2,delivery_room_management_b,,notes,"",,"999 if unknown",,,,,"[s_pe_other_2] = '1'",,RH,,,,
s_id_2,delivery_room_management_b," ",radio,"Screening for other infectious diseases? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_id_spec1_2,delivery_room_management_b,,text,"",,"999 if unknown",,,,,"[s_id_2] = '1'",,RH,,,,
s_id_date1_2,delivery_room_management_b,,text,"",,,date_dmy,,,,"[s_id_2] = '1'",,RH,,,,
s_id_pos1_2,delivery_room_management_b,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_2] = '1'",,,,,,
s_id_add1_2,delivery_room_management_b,,checkbox,"","1,",,,,,,"[s_id_2] = '1'",,RH,,,,
s_id_spec2_2,delivery_room_management_b,,text,"",,,,,,,"[s_id_add1_2(1)] = '1'",,RH,,,,
s_id_date2_2,delivery_room_management_b,,text,"",,,date_dmy,,,,"[s_id_add1_2(1)] = '1'",,RH,,,,
s_id_pos2_2,delivery_room_management_b,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_add1_2(1)] = '1'",,,,,,
s_id_add2_2,delivery_room_management_b,,checkbox,"","1,",,,,,,"[s_id_add1_2(1)] = '1'",,RH,,,,
s_id_spec3_2,delivery_room_management_b,,text,"",,,,,,,"[s_id_add2_2(1)] = '1'",,RH,,,,
s_id_date3_2,delivery_room_management_b,,text,"",,,date_dmy,,,,"[s_id_add2_2(1)] = '1'",,RH,,,,
s_id_pos3_2,delivery_room_management_b,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_add2_2(1)] = '1'",,,,,,
s_bc_2,delivery_room_management_b," ",radio,"Blood count","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_bc_date_2,delivery_room_management_b,,text,"",,,date_dmy,,,,"[s_bc_2] = '1'",,RH,,,,
s_bc_time_2,delivery_room_management_b,,text,"",,,time,,,,"[s_bc_2] = '1'",,RH,,,,
s_bc_res_2,delivery_room_management_b,,radio,"","1, Positive/abnormal | 2, Negative/normal | 999, Unknown",,,,,,"[s_bc_2] = '1'",,,,,,
s_bc_rep_s_2,delivery_room_management_b,,text,"",,"999 if unknown",,,,,"[s_bc_res_2] = '1'",,RH,,,,
s_othinv_2,delivery_room_management_b," ",radio,"Other investigations?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othinv_spec1_2,delivery_room_management_b,,text,"",,,,,,,"[s_othinv_2] = '1'",,RH,,,,
s_othinv_date1_2,delivery_room_management_b,,text,"",,,date_dmy,,,,"[s_othinv_2] = '1'",,RH,,,,
s_othinv_pos1_2,delivery_room_management_b,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_2] = '1'",,,,,,
s_othinv_add1_2,delivery_room_management_b,,checkbox,"","1,",,,,,,"[s_othinv_2] = '1'",,RH,,,,
s_othinv_spec2_2,delivery_room_management_b,,text,"",,,,,,,"[s_othinv_add1_2(1)] = '1'",,RH,,,,
s_othinv_date2_2,delivery_room_management_b,,text,"",,,date_dmy,,,,"[s_othinv_add1_2(1)] = '1'",,RH,,,,
s_othinv_pos2_2,delivery_room_management_b,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_add1_2(1)] = '1'",,,,,,
s_othinv_add2_2,delivery_room_management_b,,checkbox,"","1,",,,,,,"[s_othinv_add1_2(1)] = '1'",,RH,,,,
s_othinv_spec3_2,delivery_room_management_b,,text,"",,,,,,,"[s_othinv_add2_2(1)] = '1'",,RH,,,,
s_othinv_date3_2,delivery_room_management_b,,text,"",,,date_dmy,,,,"[s_othinv_add2_2(1)] = '1'",,RH,,,,
s_othinv_pos3_2,delivery_room_management_b,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_add2_2(1)] = '1'",,,,,,
s_healthevents_2,delivery_room_management_b," ",radio,"Any infant health events / issues between birth and discharge","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
s_jaundice_2,delivery_room_management_b,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_2] = '1'",,RH,,,,
s_jaundice_des_2,delivery_room_management_b,,text,"",,,,,,,"[s_jaundice_2] = '1'",,RH,,,,
s_jaundice_photo_2,delivery_room_management_b,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_jaundice_2] = '1'",,RH,,,,
s_seizures_2,delivery_room_management_b,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_2] = '1'",,RH,,,,
s_seizures_des_2,delivery_room_management_b,,text,"",,,,,,,"[s_seizures_2] = '1'",,RH,,,,
s_hypoglycemia_2,delivery_room_management_b,,radio,"Hypoglycemia (glucometer < 2.6mmol/L)
","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_2] = '1'",,RH,,,,
s_hypoglycemia_des_2,delivery_room_management_b,,text,"",,,,,,,"[s_hypoglycemia_2] = '1'",,RH,,,,
s_infdeath_2,delivery_room_management_b,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_2] = '1'",,RH,,,,
s_infdeath_desc_2,delivery_room_management_b,,descriptive,"Please complete infant death form
",,,,,,,"[s_infdeath_2] = '1'",,,,,,
s_nicu_2,delivery_room_management_b,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_2] = '1'",,RH,,,,
s_nicu_desc_2,delivery_room_management_b,,descriptive,"Complete NICU form, including all diagnoses in NICU
",,,,,,,"[s_nicu_2] = '1'",,,,,,
s_otherissues_2,delivery_room_management_b,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_2] = '1'",,RH,,,,
s_otherissues_des_2,delivery_room_management_b,,text,"",,"999 if unknown",,,,,"[s_otherissues_2] = '1'",,RH,,,,
s_manage_desc_2,delivery_room_management_b," ",descriptive,"NOTE: If mother and baby are both doing well/asymptomatic (e.g. if mother has recovered from COVID), select option A for mother, and leave three sub-options related to baby blank/unselected, as not applicable.
",,,,,,,,,,,,,
s_manage_2,delivery_room_management_b,,radio,"Infant management:","1, A) Mother asymptomatic or mild symptoms: able to do self care out of hospital/ not hospitalized for COVID | 2, B) Mother symptomatic requires ongoing hospitalization for management of COVID, but not critical care | 3, C) Mother in critical care for COVID | 999, D) Unknown | 998, E) Other",,,,,,,,LV,,,,
s_manage_oth_2,delivery_room_management_b,,text,"",,,,,,,"[s_manage_2] = '998'",,,,,,
s_manage_asym_2,delivery_room_management_b,,radio,,"1, Baby in joint isolation with mother in postpartum: with skin-to-skin contact and/or breastfeeding | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage_2] = '1'",,LV,,,,
s_manage_sym_2,delivery_room_management_b,,radio,,"1, Baby in joint isolation with mother in postpartum: with skin-to-skin contact and/or breastfeeding | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage_2] = '2'",,LV,,,,
s_manage_crit_2,delivery_room_management_b,,radio,,"1, Baby allowed close contact with mum - skin to skin contact or within 2 m | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage_2] = '3'",,LV,,,,
s_manage_iso_days_2,delivery_room_management_b,,text,"",,"999 if unknown",number,,,,"[s_manage_asym_2] = '2' or [s_manage_sym_2] = '2' or [s_manage_crit_2] = '2'",,,,,,
s_manage_iso_loc_2,delivery_room_management_b,,radio,"Location of baby isolation
","1, Postpartum ward | 2, Special Care Nursery | 998, Other","999 if unknown",,,,,"[s_manage_asym_2] = '2' or [s_manage_sym_2] = '2' or [s_manage_crit_2] = '2'",,,,,,
s_manage_iso_loc_oth_2,delivery_room_management_b,,text,"",,"999 if unknown",,,,,"[s_manage_iso_loc_2] = '998'",,,,,,
s_bf_2,delivery_room_management_b," ",radio,"Was breast feeding started right after birth? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_bf_when_2,delivery_room_management_b,,text,"If not, at which day of life was breast feeding started?
",,"days of life; 999 if unknown",number,,,,"[s_bf_2] = '0' and [s_bf_never_2(1)] = '0'",,RH,,,,
s_bf_never_2,delivery_room_management_b,,checkbox,"Not started prior to dischargeÂ
","1,",,,,,,"[s_bf_2] = '0' and [s_bf_when_2] = ''",,RH,,,,
s_bf_delay_2,delivery_room_management_b,,radio,"Was breastfeeding delayed because COVID+ or suspected COVID+? Â
","0, No | 1, Yes | 999, Unknown",,,,,,"[s_bf_2] = '0'",,RH,,,,
s_feed_bf_2,delivery_room_management_b,"Type of feeding through first 48 hours",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
s_feed_express_2,delivery_room_management_b,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_2,,
s_feed_form_2,delivery_room_management_b,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_2,,
s_feed_donor_2,delivery_room_management_b,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_2,,
s_feed_iv_2,delivery_room_management_b,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_2,,
s_meds_desc_2,delivery_room_management_b," Infant medications",descriptive,"Medications given to infant (not including those administered in NICU, complete NICU information form)",,,,,,,,,,,,,
s_erythro_2,delivery_room_management_b,,radio,"Erythromycin (eye prophylaxis)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_vitk_2,delivery_room_management_b,,radio,"Vitamin K","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othermeds_2,delivery_room_management_b,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othermeds_s1_2,delivery_room_management_b,,text,"",,,,,,,"[s_othermeds_2] = '1'",,RH,,,,
s_othermeds_ind1_2,delivery_room_management_b,,text,"",,,,,,,"[s_othermeds_2] = '1'",,RH,,,,
s_othermeds_add1_2,delivery_room_management_b,,checkbox,"","1,",,,,,,"[s_othermeds_2] = '1'",,RH,,,,
s_othermeds_s2_2,delivery_room_management_b,,text,"",,,,,,,"[s_othermeds_add1_2(1)] = '1'",,RH,,,,
s_othermeds_ind2_2,delivery_room_management_b,,text,"",,,,,,,"[s_othermeds_add1_2(1)] = '1'",,RH,,,,
s_othermeds_add2_2,delivery_room_management_b,,checkbox,"","1,",,,,,,"[s_othermeds_add1_2(1)] = '1'",,RH,,,,
s_othermeds_s3_2,delivery_room_management_b,,text,"",,,,,,,"[s_othermeds_add2_2(1)] = '1'",,RH,,,,
s_othermeds_ind3_2,delivery_room_management_b,,text,"",,,,,,,"[s_othermeds_add2_2(1)] = '1'",,RH,,,,
s_comments_2,delivery_room_management_b,,notes,"General comments",,,,,,,,,,,,,
s_baby_3,delivery_room_management_c,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
s_apgar_1_3,delivery_room_management_c,APGARs,text,"",,"999 if unknown",,,,,,,,,,,
s_apgar_5_3,delivery_room_management_c,,text,"",,"999 if unknown",,,,,,,,,,,
s_apgar_10_3,delivery_room_management_c,,text,"",,"999 if unknown",,,,,"[s_apgar_10_notdone_3(1)] = ''",,,,,,
s_apgar_10_notdone_3,delivery_room_management_c,,checkbox,"","1,",,,,,,,,,,,,
s_resus_any_3,delivery_room_management_c,,radio,"Any oxygen & resuscitation needs?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
s_freeflow_3,delivery_room_management_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_3] = '1'",,RH,,,,
s_freeflow_desc_3,delivery_room_management_c,,text,"",,,,,,,"[s_freeflow_3] = '1'",,RH,,,,
s_ippv_3,delivery_room_management_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_3] = '1'",,RH,,,,
s_ippv_desc_3,delivery_room_management_c,,text,"",,,,,,,"[s_ippv_3] = '1'",,RH,,,,
s_intubation_3,delivery_room_management_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_3] = '1'",,RH,,,,
s_intubation_desc_3,delivery_room_management_c,,text,"",,,,,,,"[s_intubation_3] = '1'",,RH,,,,
s_cpap_3,delivery_room_management_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_3] = '1'",,RH,,,,
s_cpap_desc_3,delivery_room_management_c,,text,"",,,,,,,"[s_cpap_3] = '1'",,RH,,,,
s_cpr_3,delivery_room_management_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_3] = '1'",,RH,,,,
s_cpr_desc_3,delivery_room_management_c,,text,"",,,,,,,"[s_cpr_3] = '1'",,RH,,,,
s_resus_oth_3,delivery_room_management_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,"[s_resus_any_3] = '1'",,RH,,,,
s_resus_oth_des_3,delivery_room_management_c,,text,"",,,,,,,"[s_resus_oth_3] = '1'",,RH,,,,
s_bw_units_3,delivery_room_management_c," ",radio,"","1, lbs+oz | 2, gm | 999, Unknown",,,,,,,,RH,,,,
s_bw_lb_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_bw_units_3] = '1'",,RH,,,,
s_bw_oz_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_bw_units_3] = '1'",,RH,,,,
s_bw_gm_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_bw_units_3] = '2'",,RH,,,,
s_len_units_3,delivery_room_management_c,,radio,"Birth length","1, in | 2, cm | 999, Unknown",,,,,,,,RH,,,,
s_len_in_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_len_units_3] = '1'",,RH,,,,
s_len_cm_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_len_units_3] = '2'",,RH,,,,
s_circ_units_3,delivery_room_management_c,,radio,"Birth head circ","1, in | 2, cm | 999, Unknown",,,,,,,,RH,,,,
s_circ_in_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_circ_units_3] = '1'",,RH,,,,
s_circ_cm_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_circ_units_3] = '2'",,RH,,,,
s_delayedcc_3,delivery_room_management_c,,radio,"Delayed cord clamping","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_delayedcc_dur_3,delivery_room_management_c,,text,"If yes, duration (seconds)
",,"999 if unknown",number,,,,"[s_delayedcc_3] = '1'",,RH,,,,
s_pe_date_3,delivery_room_management_c,"Initial physical examination",text,"Date (leave empty if done at birth)",,,date_dmy,,,,,,RH,,,,
s_pe_time_3,delivery_room_management_c,,text,"Time (leave empty if done at birth)",,,time,,,,,,RH,,,,
s_pe_resp_3,delivery_room_management_c,,radio,"Respiratory exam","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_resp_ab_3,delivery_room_management_c,,radio,"","1, Tachypnea | 2, Dyspnea | 3, Cyanosis",,,,,,"[s_pe_resp_3] = '2'",,RH,,,,
s_pe_cv_3,delivery_room_management_c,,radio,"Cardiovascular system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_cv_ab_3,delivery_room_management_c,,radio,"","1, Poorly perfused | 2, Heart murmur | 3, Cyanosis",,,,,,"[s_pe_cv_3] = '2'",,RH,,,,
s_pe_abdo_3,delivery_room_management_c,,radio,"Abdominal system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_abdo_ab_3,delivery_room_management_c,,radio,"","1, Hepatomegaly | 2, Splenomegaly",,,,,,"[s_pe_abdo_3] = '2'",,RH,,,,
s_pe_neuro_3,delivery_room_management_c,,radio,"Neurological system","1, Normal | 2, Abnormal | 888, Not checked",,,,,,,,RH,,,,
s_pe_neuro_ab_3,delivery_room_management_c,,radio,"","1, Tone | 2, Tendon reflexes | 3, Power",,,,,,"[s_pe_neuro_3] = '2'",,RH,,,,
s_pe_genitalia_3,delivery_room_management_c,,radio,Genitalia,"1, Male | 2, Female | 3, Ambiguous",,,,,,,,RH,,,,
s_pe_dysmorph_3,delivery_room_management_c,,radio,Dysmorphism,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_pe_dysmorph_desc_3,delivery_room_management_c,,notes,"",,"999 if unknown",,,,,"[s_pe_dysmorph_3] = '1'",,RH,,,,
s_pe_other_3,delivery_room_management_c,,radio,"Any other significant findings? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_pe_other_desc_3,delivery_room_management_c,,notes,"",,"999 if unknown",,,,,"[s_pe_other_3] = '1'",,RH,,,,
s_id_3,delivery_room_management_c," ",radio,"Screening for other infectious diseases? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_id_spec1_3,delivery_room_management_c,,text,"",,"999 if unknown",,,,,"[s_id_3] = '1'",,RH,,,,
s_id_date1_3,delivery_room_management_c,,text,"",,,date_dmy,,,,"[s_id_3] = '1'",,RH,,,,
s_id_pos1_3,delivery_room_management_c,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_3] = '1'",,,,,,
s_id_add1_3,delivery_room_management_c,,checkbox,"","1,",,,,,,"[s_id_3] = '1'",,RH,,,,
s_id_spec2_3,delivery_room_management_c,,text,"",,,,,,,"[s_id_add1_3(1)] = '1'",,RH,,,,
s_id_date2_3,delivery_room_management_c,,text,"",,,date_dmy,,,,"[s_id_add1_3(1)] = '1'",,RH,,,,
s_id_pos2_3,delivery_room_management_c,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_add1_3(1)] = '1'",,,,,,
s_id_add2_3,delivery_room_management_c,,checkbox,"","1,",,,,,,"[s_id_add1_3(1)] = '1'",,RH,,,,
s_id_spec3_3,delivery_room_management_c,,text,"",,,,,,,"[s_id_add2_3(1)] = '1'",,RH,,,,
s_id_date3_3,delivery_room_management_c,,text,"",,,date_dmy,,,,"[s_id_add2_3(1)] = '1'",,RH,,,,
s_id_pos3_3,delivery_room_management_c,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_id_add2_3(1)] = '1'",,,,,,
s_bc_3,delivery_room_management_c," ",radio,"Blood count","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_bc_date_3,delivery_room_management_c,,text,"",,,date_dmy,,,,"[s_bc_3] = '1'",,RH,,,,
s_bc_time_3,delivery_room_management_c,,text,"",,,time,,,,"[s_bc_3] = '1'",,RH,,,,
s_bc_res_3,delivery_room_management_c,,radio,"","1, Positive/abnormal | 2, Negative/normal | 999, Unknown",,,,,,"[s_bc_3] = '1'",,,,,,
s_bc_rep_s_3,delivery_room_management_c,,text,"",,"999 if unknown",,,,,"[s_bc_res_3] = '1'",,RH,,,,
s_othinv_3,delivery_room_management_c," ",radio,"Other investigations?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othinv_spec1_3,delivery_room_management_c,,text,"",,,,,,,"[s_othinv_3] = '1'",,RH,,,,
s_othinv_date1_3,delivery_room_management_c,,text,"",,,date_dmy,,,,"[s_othinv_3] = '1'",,RH,,,,
s_othinv_pos1_3,delivery_room_management_c,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_3] = '1'",,,,,,
s_othinv_add1_3,delivery_room_management_c,,checkbox,"","1,",,,,,,"[s_othinv_3] = '1'",,RH,,,,
s_othinv_spec2_3,delivery_room_management_c,,text,"",,,,,,,"[s_othinv_add1_3(1)] = '1'",,RH,,,,
s_othinv_date2_3,delivery_room_management_c,,text,"",,,date_dmy,,,,"[s_othinv_add1_3(1)] = '1'",,RH,,,,
s_othinv_pos2_3,delivery_room_management_c,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_add1_3(1)] = '1'",,,,,,
s_othinv_add2_3,delivery_room_management_c,,checkbox,"","1,",,,,,,"[s_othinv_add1_3(1)] = '1'",,RH,,,,
s_othinv_spec3_3,delivery_room_management_c,,text,"",,,,,,,"[s_othinv_add2_3(1)] = '1'",,RH,,,,
s_othinv_date3_3,delivery_room_management_c,,text,"",,,date_dmy,,,,"[s_othinv_add2_3(1)] = '1'",,RH,,,,
s_othinv_pos3_3,delivery_room_management_c,,radio,"","1, Positive / abnormal | 0, Negative / normal | 999, Unknown",,,,,,"[s_othinv_add2_3(1)] = '1'",,,,,,
s_healthevents_3,delivery_room_management_c," ",radio,"Any infant health events / issues between birth and discharge","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
s_jaundice_3,delivery_room_management_c,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_3] = '1'",,RH,,,,
s_jaundice_des_3,delivery_room_management_c,,text,"",,,,,,,"[s_jaundice_3] = '1'",,RH,,,,
s_jaundice_photo_3,delivery_room_management_c,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_jaundice_3] = '1'",,RH,,,,
s_seizures_3,delivery_room_management_c,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_3] = '1'",,RH,,,,
s_seizures_des_3,delivery_room_management_c,,text,"",,,,,,,"[s_seizures_3] = '1'",,RH,,,,
s_hypoglycemia_3,delivery_room_management_c,,radio,"Hypoglycemia (glucometer < 2.6mmol/L)
","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_3] = '1'",,RH,,,,
s_hypoglycemia_des_3,delivery_room_management_c,,text,"",,,,,,,"[s_hypoglycemia_3] = '1'",,RH,,,,
s_infdeath_3,delivery_room_management_c,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_3] = '1'",,RH,,,,
s_infdeath_desc_3,delivery_room_management_c,,descriptive,"Please complete infant death form
",,,,,,,"[s_infdeath_3] = '1'",,,,,,
s_nicu_3,delivery_room_management_c,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_3] = '1'",,RH,,,,
s_nicu_desc_3,delivery_room_management_c,,descriptive,"Complete NICU form, including all diagnoses in NICU
",,,,,,,"[s_nicu_3] = '1'",,,,,,
s_otherissues_3,delivery_room_management_c,,radio,"","0, No | 1, Yes | 999, Unknown",,,,,,"[s_healthevents_3] = '1'",,RH,,,,
s_otherissues_des_3,delivery_room_management_c,,text,"",,"999 if unknown",,,,,"[s_otherissues_3] = '1'",,RH,,,,
s_manage_desc_3,delivery_room_management_c," ",descriptive,"NOTE: If mother and baby are both doing well/asymptomatic (e.g. if mother has recovered from COVID), select option A for mother, and leave three sub-options related to baby blank/unselected, as not applicable.
",,,,,,,,,,,,,
s_manage_3,delivery_room_management_c,,radio,"Infant management:","1, A) Mother asymptomatic or mild symptoms: able to do self care out of hospital/ not hospitalized for COVID | 2, B) Mother symptomatic requires ongoing hospitalization for management of COVID, but not critical care | 3, C) Mother in critical care for COVID | 999, D) Unknown | 998, E) Other",,,,,,,,LV,,,,
s_manage_oth_3,delivery_room_management_c,,text,"",,,,,,,"[s_manage_3] = '998'",,,,,,
s_manage_asym_3,delivery_room_management_c,,radio,,"1, Baby in joint isolation with mother in postpartum: with skin-to-skin contact and/or breastfeeding | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage_3] = '1'",,LV,,,,
s_manage_sym_3,delivery_room_management_c,,radio,,"1, Baby in joint isolation with mother in postpartum: with skin-to-skin contact and/or breastfeeding | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage_3] = '2'",,LV,,,,
s_manage_crit_3,delivery_room_management_c,,radio,,"1, Baby allowed close contact with mum - skin to skin contact or within 2 m | 2, Asymptomatic baby isolated away from mum | 3, Symptomatic baby transferred to SCN or NICU care",,,,,,"[s_manage_3] = '3'",,LV,,,,
s_manage_iso_days_3,delivery_room_management_c,,text,"",,"999 if unknown",number,,,,"[s_manage_asym_3] = '2' or [s_manage_sym_3] = '2' or [s_manage_crit_3] = '2'",,,,,,
s_manage_iso_loc_3,delivery_room_management_c,,radio,"Location of baby isolation
","1, Postpartum ward | 2, Special Care Nursery | 998, Other","999 if unknown",,,,,"[s_manage_asym_3] = '2' or [s_manage_sym_3] = '2' or [s_manage_crit_3] = '2'",,,,,,
s_manage_iso_loc_oth_3,delivery_room_management_c,,text,"",,"999 if unknown",,,,,"[s_manage_iso_loc_3] = '998'",,,,,,
s_bf_3,delivery_room_management_c," ",radio,"Was breast feeding started right after birth? ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_bf_when_3,delivery_room_management_c,,text,"If not, at which day of life was breast feeding started?
",,"days of life; 999 if unknown",number,,,,"[s_bf_3] = '0' and [s_bf_never_3(1)] = '0'",,RH,,,,
s_bf_never_3,delivery_room_management_c,,checkbox,"Not started prior to dischargeÂ
","1,",,,,,,"[s_bf_3] = '0' and [s_bf_when_3] = ''",,RH,,,,
s_bf_delay_3,delivery_room_management_c,,radio,"Was breastfeeding delayed because COVID+ or suspected COVID+? Â
","0, No | 1, Yes | 999, Unknown",,,,,,"[s_bf_3] = '0'",,RH,,,,
s_feed_bf_3,delivery_room_management_c,"Type of feeding through first 48 hours",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
s_feed_express_3,delivery_room_management_c,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_3,,
s_feed_form_3,delivery_room_management_c,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_3,,
s_feed_donor_3,delivery_room_management_c,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_3,,
s_feed_iv_3,delivery_room_management_c,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,x_feed_3,,
s_meds_desc_3,delivery_room_management_c," Infant medications",descriptive,"Medications given to infant (not including those administered in NICU, complete NICU information form)",,,,,,,,,,,,,
s_erythro_3,delivery_room_management_c,,radio,"Erythromycin (eye prophylaxis)","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_vitk_3,delivery_room_management_c,,radio,"Vitamin K","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othermeds_3,delivery_room_management_c,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
s_othermeds_s1_3,delivery_room_management_c,,text,"",,,,,,,"[s_othermeds_3] = '1'",,RH,,,,
s_othermeds_ind1_3,delivery_room_management_c,,text,"",,,,,,,"[s_othermeds_3] = '1'",,RH,,,,
s_othermeds_add1_3,delivery_room_management_c,,checkbox,"","1,",,,,,,"[s_othermeds_3] = '1'",,RH,,,,
s_othermeds_s2_3,delivery_room_management_c,,text,"",,,,,,,"[s_othermeds_add1_3(1)] = '1'",,RH,,,,
s_othermeds_ind2_3,delivery_room_management_c,,text,"",,,,,,,"[s_othermeds_add1_3(1)] = '1'",,RH,,,,
s_othermeds_add2_3,delivery_room_management_c,,checkbox,"","1,",,,,,,"[s_othermeds_add1_3(1)] = '1'",,RH,,,,
s_othermeds_s3_3,delivery_room_management_c,,text,"",,,,,,,"[s_othermeds_add2_3(1)] = '1'",,RH,,,,
s_othermeds_ind3_3,delivery_room_management_c,,text,"",,,,,,,"[s_othermeds_add2_3(1)] = '1'",,RH,,,,
s_comments_3,delivery_room_management_c,,notes,"General comments",,,,,,,,,,,,,
t_nicu,nicu_information_a,,radio,"Was there a NICU admission?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
t_baby,nicu_information_a,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,"[t_nicu] = '1'",,RH,,,,
t_nicu_admission,nicu_information_a,,text,"NICU admission date",,,date_dmy,,,,"[t_nicu] = '1'",,,,,,
t_nicu_discharge,nicu_information_a,,text,"NICU discharge date",,,date_dmy,,,,"[t_nicu] = '1'",,,,,,
t_nicu_levels,nicu_information_a,,checkbox,"Levels of NICU care needed","1, Level I | 2, Level II | 3, Level III | 999, Not sure",,,,,,"[t_nicu] = '1'",,,,,,
t_nicu_name,nicu_information_a,,text,"Name of NICU providing highest level of care",,"999 if unknown",,,,,"[t_nicu] = '1'",,,,,,
t_diag_any,nicu_information_a," ",radio,"Any diagnoses given in NICU?","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_diag_resp,nicu_information_a,,checkbox,"","1, Respiratory distress syndrome | 2, Transient tachypnoea of newborn | 3, Meconium aspiration syndrome | 4, Bronchopulmonary dysplasia | 5, Congenital pneumonia | 6, Ventilator-associated pneumonia | 7, Pneumothorax | 8, Pleural effusion | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any] = '1'",,,,,,
t_diag_resp_oth,nicu_information_a,,text,"",,"999 if unknown",,,,,"[t_diag_resp(998)] = '1'",,,,,,
t_diag_cardio,nicu_information_a,,checkbox,"","1, Hypotension requiring inotropes/steroids | 2, Persistent Pulmonary hypertension | 3, Patent ductus arteriosus | 4, Myocarditis | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any] = '1'",,,,,,
t_diag_cardio_oth,nicu_information_a,,text,"",,"999 if unknown",,,,,"[t_diag_cardio(998)] = '1'",,,,,,
t_diag_gastro,nicu_information_a,,checkbox,"","1, Spontaneous Intestinal Perforation | 2, Cow's milk protein allergy | 3, Cholestasis (Bc>20umol/L) | 4, Necrotising enterocolitis | 5, Intestinal obstruction | 6, Elevated ALT and/or AST | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any] = '1'",,,,,,
t_diag_gastro_oth,nicu_information_a,,text,"",,"999 if unknown",,,,,"[t_diag_gastro(998)] = '1'",,,,,,
t_diag_infec,nicu_information_a,,checkbox,"","1, Culture proven sepsis | 2, Urinary tract infection | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any] = '1'",,,,,,
t_diag_infec_oth,nicu_information_a,,text,"",,"999 if unknown",,,,,"[t_diag_infec(998)] = '1'",,,,,,
t_diag_neuro,nicu_information_a,,checkbox,"","1, Intraventricular haemorrhage | 2, Neonatal seizure | 3, Hydrocephalus | 4, Periventicular leucomalacia | 5, Hypoxic-ischemic encephalopathy | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any] = '1'",,,,,,
t_diag_neuro_oth,nicu_information_a,,text,"",,"999 if unknown",,,,,"[t_diag_neuro(998)] = '1'",,,,,,
t_diag_hem,nicu_information_a,,checkbox,"","1, Thrombocytopenia (PLT< 100x10^9/L) | 2, Leukopenia (WBC< 5x10^9/L) | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any] = '1'",,,,,,
t_diag_hem_oth,nicu_information_a,,text,"",,"999 if unknown",,,,,"[t_diag_hem(998)] = '1'",,,,,,
t_care_resp,nicu_information_a,"Care requirement at NICU",radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_care_inv,nicu_information_a,,checkbox,"Invasive mechanical ventilation
","1,",,,,,,"[t_care_resp] = '1'",,,,,,
t_care_inv_dur,nicu_information_a,,text,"",,"999 if unknown",number,,,,"[t_care_inv(1)] = '1'",,,,,,
t_care_noninv,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_resp] = '1'",,,,,,
t_care_noninv_dur,nicu_information_a,,text,"",,"999 if unknown",number,,,,"[t_care_noninv(1)] = '1'",,,,,,
t_care_surf,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_resp] = '1'",,,,,,
t_care_surf_doses,nicu_information_a,,text,"",,"999 if unknown",number,,,,"[t_care_surf(1)] = '1'",,,,,,
t_care_nitric,nicu_information_a,,checkbox,"Use of inhaled nitric oxide
","1,",,,,,,"[t_care_resp] = '1'",,,,,,
t_care_nitric_dur,nicu_information_a,,text,"",,"999 if unknown",number,,,,"[t_care_nitric(1)] = '1'",,,,,,
t_care_cardio,nicu_information_a,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_care_ecmo,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_cardio] = '1'",,,,,,
t_care_ecmo_dur,nicu_information_a,,text,"",,"999 if unknown",number,,,,"[t_care_ecmo(1)] = '1'",,,,,,
t_care_gastro,nicu_information_a,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_care_nut,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_gastro] = '1'",,,,,,
t_care_nut_dur,nicu_information_a,,text,"",,"999 if unknown",number,,,,"[t_care_nut(1)] = '1'",,,,,,
t_care_surg,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_gastro] = '1'",,,,,,
t_care_surg_des,nicu_information_a,,text,"",,"999 if unknown",,,,,"[t_care_surg(1)] = '1'",,,,,,
t_care_neuro,nicu_information_a,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_care_hypo,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_neuro] = '1'",,,,,,
t_care_eeg,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_neuro] = '1'",,,,,,
t_care_lumbar,nicu_information_a,,checkbox,"Lumbar puncture for any reason
","1,",,,,,,"[t_care_neuro] = '1'",,,,,,
t_care_lumbar_findings,nicu_information_a,,notes,"",,"999 if unknown",,,,,"[t_care_lumbar(1)] = '1'",,,,,,
t_care_imag,nicu_information_a,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_care_xray,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_imag] = '1'",,,,,,
t_care_xray_findings,nicu_information_a,,notes,"",,"999 if unknown",,,,,"[t_care_xray(1)] = '1'",,,,,,
t_care_us,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_imag] = '1'",,,,,,
t_care_us_findings,nicu_information_a,,notes,"",,"999 if unknown",,,,,"[t_care_us(1)] = '1'",,,,,,
t_care_mri,nicu_information_a,,checkbox,"","1,",,,,,,"[t_care_imag] = '1'",,,,,,
t_care_mri_findings,nicu_information_a,,notes,"",,"999 if unknown",,,,,"[t_care_mri(1)] = '1'",,,,,,
t_dischargeto,nicu_information_a," ",radio,"Discharged from NICU to","1, Home | 2, Hospital | 998, Other | 999, Unknown",,,,,,"[t_nicu] = '1'",,,,,,
t_dischargeto_hosp,nicu_information_a,,text,"",,,,,,,"[t_dischargeto] = '998'",,,,,,
t_meds_desc,nicu_information_a,"Infant medications in NICU",descriptive,"Medications given to infant in NICU",,,,,,,"[t_nicu] = '1'",,,,,,
t_erythro,nicu_information_a,,radio,"Erythromycin (eye prophylaxis)","0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_vitk,nicu_information_a,,radio,"Vitamin K","0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_othermeds,nicu_information_a,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu] = '1'",,RH,,,,
t_othermeds_s,nicu_information_a,,text,"",,,,,,,"[t_othermeds] = '1'",,RH,,,,
t_othermeds_ind,nicu_information_a,,text,"",,,,,,,"[t_othermeds] = '1'",,RH,,,,
t_othermeds_add1,nicu_information_a,,checkbox,"","1,",,,,,,"[t_othermeds] = '1'",,RH,,,,
t_othermeds_s2,nicu_information_a,,text,"",,,,,,,"[t_othermeds_add1(1)] = '1'",,RH,,,,
t_othermeds_ind2,nicu_information_a,,text,"",,,,,,,"[t_othermeds_add1(1)] = '1'",,RH,,,,
t_othermeds_add2,nicu_information_a,,checkbox,"","1,",,,,,,"[t_othermeds_add1(1)] = '1'",,RH,,,,
t_othermeds_s3,nicu_information_a,,text,"",,,,,,,"[t_othermeds_add2(1)] = '1'",,RH,,,,
t_othermeds_ind3,nicu_information_a,,text,"",,,,,,,"[t_othermeds_add2(1)] = '1'",,RH,,,,
t_comments,nicu_information_a," ",notes,"General comments",,,,,,,,,,,,,
t_nicu_2,nicu_information_b,,radio,"Was there a NICU admission?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
t_baby_2,nicu_information_b,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_nicu_admission_2,nicu_information_b,,text,"NICU admission date",,,date_dmy,,,,"[t_nicu_2] = '1'",,,,,,
t_nicu_discharge_2,nicu_information_b,,text,"NICU discharge date",,,date_dmy,,,,"[t_nicu_2] = '1'",,,,,,
t_nicu_levels_2,nicu_information_b,,checkbox,"Levels of NICU care needed","1, Level I | 2, Level II | 3, Level III | 999, Not sure",,,,,,"[t_nicu_2] = '1'",,,,,,
t_nicu_name_2,nicu_information_b,,text,"Name of NICU providing highest level of care",,"999 if unknown",,,,,"[t_nicu_2] = '1'",,,,,,
t_diag_any_2,nicu_information_b," ",radio,"Any diagnoses given in NICU?","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_diag_resp_2,nicu_information_b,,checkbox,"","1, Respiratory distress syndrome | 2, Transient tachypnoea of newborn | 3, Meconium aspiration syndrome | 4, Bronchopulmonary dysplasia | 5, Congenital pneumonia | 6, Ventilator-associated pneumonia | 7, Pneumothorax | 8, Pleural effusion | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_2] = '1'",,,,,,
t_diag_resp_oth_2,nicu_information_b,,text,"",,"999 if unknown",,,,,"[t_diag_resp_2(998)] = '1'",,,,,,
t_diag_cardio_2,nicu_information_b,,checkbox,"","1, Hypotension requiring inotropes/steroids | 2, Persistent Pulmonary hypertension | 3, Patent ductus arteriosus | 4, Myocarditis | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_2] = '1'",,,,,,
t_diag_cardio_oth_2,nicu_information_b,,text,"",,"999 if unknown",,,,,"[t_diag_cardio_2(998)] = '1'",,,,,,
t_diag_gastro_2,nicu_information_b,,checkbox,"","1, Spontaneous Intestinal Perforation | 2, Cow's milk protein allergy | 3, Cholestasis (Bc>20umol/L) | 4, Necrotising enterocolitis | 5, Intestinal obstruction | 6, Elevated ALT and/or AST | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_2] = '1'",,,,,,
t_diag_gastro_oth_2,nicu_information_b,,text,"",,"999 if unknown",,,,,"[t_diag_gastro_2(998)] = '1'",,,,,,
t_diag_infec_2,nicu_information_b,,checkbox,"","1, Culture proven sepsis | 2, Urinary tract infection | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_2] = '1'",,,,,,
t_diag_infec_oth_2,nicu_information_b,,text,"",,"999 if unknown",,,,,"[t_diag_infec_2(998)] = '1'",,,,,,
t_diag_neuro_2,nicu_information_b,,checkbox,"","1, Intraventricular haemorrhage | 2, Neonatal seizure | 3, Hydrocephalus | 4, Periventicular leucomalacia | 5, Hypoxic-ischemic encephalopathy | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_2] = '1'",,,,,,
t_diag_neuro_oth_2,nicu_information_b,,text,"",,"999 if unknown",,,,,"[t_diag_neuro_2(998)] = '1'",,,,,,
t_diag_hem_2,nicu_information_b,,checkbox,"","1, Thrombocytopenia (PLT< 100x10^9/L) | 2, Leukopenia (WBC< 5x10^9/L) | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_2] = '1'",,,,,,
t_diag_hem_oth_2,nicu_information_b,,text,"",,"999 if unknown",,,,,"[t_diag_hem_2(998)] = '1'",,,,,,
t_care_resp_2,nicu_information_b,"Care requirement at NICU",radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_care_inv_2,nicu_information_b,,checkbox,"Invasive mechanical ventilation
","1,",,,,,,"[t_care_resp_2] = '1'",,,,,,
t_care_inv_dur_2,nicu_information_b,,text,"",,"999 if unknown",number,,,,"[t_care_inv_2(1)] = '1'",,,,,,
t_care_noninv_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_resp_2] = '1'",,,,,,
t_care_noninv_dur_2,nicu_information_b,,text,"",,"999 if unknown",number,,,,"[t_care_noninv_2(1)] = '1'",,,,,,
t_care_surf_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_resp_2] = '1'",,,,,,
t_care_surf_doses_2,nicu_information_b,,text,"",,"999 if unknown",number,,,,"[t_care_surf_2(1)] = '1'",,,,,,
t_care_nitric_2,nicu_information_b,,checkbox,"Use of inhaled nitric oxide
","1,",,,,,,"[t_care_resp_2] = '1'",,,,,,
t_care_nitric_dur_2,nicu_information_b,,text,"",,"999 if unknown",number,,,,"[t_care_nitric_2(1)] = '1'",,,,,,
t_care_cardio_2,nicu_information_b,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_care_ecmo_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_cardio_2] = '1'",,,,,,
t_care_ecmo_dur_2,nicu_information_b,,text,"",,"999 if unknown",number,,,,"[t_care_ecmo_2(1)] = '1'",,,,,,
t_care_gastro_2,nicu_information_b,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_care_nut_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_gastro_2] = '1'",,,,,,
t_care_nut_dur_2,nicu_information_b,,text,"",,"999 if unknown",number,,,,"[t_care_nut_2(1)] = '1'",,,,,,
t_care_surg_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_gastro_2] = '1'",,,,,,
t_care_surg_des_2,nicu_information_b,,text,"",,"999 if unknown",,,,,"[t_care_surg_2(1)] = '1'",,,,,,
t_care_neuro_2,nicu_information_b,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_care_hypo_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_neuro_2] = '1'",,,,,,
t_care_eeg_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_neuro_2] = '1'",,,,,,
t_care_lumbar_2,nicu_information_b,,checkbox,"Lumbar puncture for any reason
","1,",,,,,,"[t_care_neuro_2] = '1'",,,,,,
t_care_lumbar_findings_2,nicu_information_b,,notes,"",,"999 if unknown",,,,,"[t_care_lumbar_2(1)] = '1'",,,,,,
t_care_imag_2,nicu_information_b,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_care_xray_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_imag_2] = '1'",,,,,,
t_care_xray_findings_2,nicu_information_b,,notes,"",,"999 if unknown",,,,,"[t_care_xray_2(1)] = '1'",,,,,,
t_care_us_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_imag_2] = '1'",,,,,,
t_care_us_findings_2,nicu_information_b,,notes,"",,"999 if unknown",,,,,"[t_care_us_2(1)] = '1'",,,,,,
t_care_mri_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_care_imag_2] = '1'",,,,,,
t_care_mri_findings_2,nicu_information_b,,notes,"",,"999 if unknown",,,,,"[t_care_mri_2(1)] = '1'",,,,,,
t_dischargeto_2,nicu_information_b," ",radio,"Discharged from NICU to","1, Home | 2, Hospital | 998, Other | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,,,,,
t_dischargeto_hosp_2,nicu_information_b,,text,"",,,,,,,"[t_dischargeto_2] = '998'",,,,,,
t_meds_desc_2,nicu_information_b,"Infant medications in NICU",descriptive,"Medications given to infant in NICU",,,,,,,"[t_nicu_2] = '1'",,,,,,
t_erythro_2,nicu_information_b,,radio,"Erythromycin (eye prophylaxis)","0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_vitk_2,nicu_information_b,,radio,"Vitamin K","0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_othermeds_2,nicu_information_b,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu_2] = '1'",,RH,,,,
t_othermeds_s_2,nicu_information_b,,text,"",,,,,,,"[t_othermeds_2] = '1'",,RH,,,,
t_othermeds_ind_2,nicu_information_b,,text,"",,,,,,,"[t_othermeds_2] = '1'",,RH,,,,
t_othermeds_add1_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_othermeds_2] = '1'",,RH,,,,
t_othermeds_s2_2,nicu_information_b,,text,"",,,,,,,"[t_othermeds_add1_2(1)] = '1'",,RH,,,,
t_othermeds_ind2_2,nicu_information_b,,text,"",,,,,,,"[t_othermeds_add1_2(1)] = '1'",,RH,,,,
t_othermeds_add2_2,nicu_information_b,,checkbox,"","1,",,,,,,"[t_othermeds_add1_2(1)] = '1'",,RH,,,,
t_othermeds_s3_2,nicu_information_b,,text,"",,,,,,,"[t_othermeds_add2_2(1)] = '1'",,RH,,,,
t_othermeds_ind3_2,nicu_information_b,,text,"",,,,,,,"[t_othermeds_add2_2(1)] = '1'",,RH,,,,
t_comments_2,nicu_information_b," ",notes,"General comments",,,,,,,,,,,,,
t_nicu_3,nicu_information_c,,radio,"Was there a NICU admission?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
t_baby_3,nicu_information_c,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_nicu_admission_3,nicu_information_c,,text,"NICU admission date",,,date_dmy,,,,"[t_nicu_3] = '1'",,,,,,
t_nicu_discharge_3,nicu_information_c,,text,"NICU discharge date",,,date_dmy,,,,"[t_nicu_3] = '1'",,,,,,
t_nicu_levels_3,nicu_information_c,,checkbox,"Levels of NICU care needed","1, Level I | 2, Level II | 3, Level III | 999, Not sure",,,,,,"[t_nicu_3] = '1'",,,,,,
t_nicu_name_3,nicu_information_c,,text,"Name of NICU providing highest level of care",,"999 if unknown",,,,,"[t_nicu_3] = '1'",,,,,,
t_diag_any_3,nicu_information_c," ",radio,"Any diagnoses given in NICU?","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_diag_resp_3,nicu_information_c,,checkbox,"","1, Respiratory distress syndrome | 2, Transient tachypnoea of newborn | 3, Meconium aspiration syndrome | 4, Bronchopulmonary dysplasia | 5, Congenital pneumonia | 6, Ventilator-associated pneumonia | 7, Pneumothorax | 8, Pleural effusion | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_3] = '1'",,,,,,
t_diag_resp_oth_3,nicu_information_c,,text,"",,"999 if unknown",,,,,"[t_diag_resp_3(998)] = '1'",,,,,,
t_diag_cardio_3,nicu_information_c,,checkbox,"","1, Hypotension requiring inotropes/steroids | 2, Persistent Pulmonary hypertension | 3, Patent ductus arteriosus | 4, Myocarditis | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_3] = '1'",,,,,,
t_diag_cardio_oth_3,nicu_information_c,,text,"",,"999 if unknown",,,,,"[t_diag_cardio_3(998)] = '1'",,,,,,
t_diag_gastro_3,nicu_information_c,,checkbox,"","1, Spontaneous Intestinal Perforation | 2, Cow's milk protein allergy | 3, Cholestasis (Bc>20umol/L) | 4, Necrotising enterocolitis | 5, Intestinal obstruction | 6, Elevated ALT and/or AST | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_3] = '1'",,,,,,
t_diag_gastro_oth_3,nicu_information_c,,text,"",,"999 if unknown",,,,,"[t_diag_gastro_3(998)] = '1'",,,,,,
t_diag_infec_3,nicu_information_c,,checkbox,"","1, Culture proven sepsis | 2, Urinary tract infection | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_3] = '1'",,,,,,
t_diag_infec_oth_3,nicu_information_c,,text,"",,"999 if unknown",,,,,"[t_diag_infec_3(998)] = '1'",,,,,,
t_diag_neuro_3,nicu_information_c,,checkbox,"","1, Intraventricular haemorrhage | 2, Neonatal seizure | 3, Hydrocephalus | 4, Periventicular leucomalacia | 5, Hypoxic-ischemic encephalopathy | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_3] = '1'",,,,,,
t_diag_neuro_oth_3,nicu_information_c,,text,"",,"999 if unknown",,,,,"[t_diag_neuro_3(998)] = '1'",,,,,,
t_diag_hem_3,nicu_information_c,,checkbox,"","1, Thrombocytopenia (PLT< 100x10^9/L) | 2, Leukopenia (WBC< 5x10^9/L) | 998, Others | 0, None | 999, Unknown",,,,,,"[t_diag_any_3] = '1'",,,,,,
t_diag_hem_oth_3,nicu_information_c,,text,"",,"999 if unknown",,,,,"[t_diag_hem_3(998)] = '1'",,,,,,
t_care_resp_3,nicu_information_c,"Care requirement at NICU",radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_care_inv_3,nicu_information_c,,checkbox,"Invasive mechanical ventilation
","1,",,,,,,"[t_care_resp_3] = '1'",,,,,,
t_care_inv_dur_3,nicu_information_c,,text,"",,"999 if unknown",number,,,,"[t_care_inv_3(1)] = '1'",,,,,,
t_care_noninv_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_resp_3] = '1'",,,,,,
t_care_noninv_dur_3,nicu_information_c,,text,"",,"999 if unknown",number,,,,"[t_care_noninv_3(1)] = '1'",,,,,,
t_care_surf_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_resp_3] = '1'",,,,,,
t_care_surf_doses_3,nicu_information_c,,text,"",,"999 if unknown",number,,,,"[t_care_surf_3(1)] = '1'",,,,,,
t_care_nitric_3,nicu_information_c,,checkbox,"Use of inhaled nitric oxide
","1,",,,,,,"[t_care_resp_3] = '1'",,,,,,
t_care_nitric_dur_3,nicu_information_c,,text,"",,"999 if unknown",number,,,,"[t_care_nitric_3(1)] = '1'",,,,,,
t_care_cardio_3,nicu_information_c,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_care_ecmo_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_cardio_3] = '1'",,,,,,
t_care_ecmo_dur_3,nicu_information_c,,text,"",,"999 if unknown",number,,,,"[t_care_ecmo_3(1)] = '1'",,,,,,
t_care_gastro_3,nicu_information_c,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_care_nut_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_gastro_3] = '1'",,,,,,
t_care_nut_dur_3,nicu_information_c,,text,"",,"999 if unknown",number,,,,"[t_care_nut_3(1)] = '1'",,,,,,
t_care_surg_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_gastro_3] = '1'",,,,,,
t_care_surg_des_3,nicu_information_c,,text,"",,"999 if unknown",,,,,"[t_care_surg_3(1)] = '1'",,,,,,
t_care_neuro_3,nicu_information_c,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_care_hypo_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_neuro_3] = '1'",,,,,,
t_care_eeg_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_neuro_3] = '1'",,,,,,
t_care_lumbar_3,nicu_information_c,,checkbox,"Lumbar puncture for any reason
","1,",,,,,,"[t_care_neuro_3] = '1'",,,,,,
t_care_lumbar_findings_3,nicu_information_c,,notes,"",,"999 if unknown",,,,,"[t_care_lumbar_3(1)] = '1'",,,,,,
t_care_imag_3,nicu_information_c,,radio,"","1, Yes | 0, No | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_care_xray_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_imag_3] = '1'",,,,,,
t_care_xray_findings_3,nicu_information_c,,notes,"",,"999 if unknown",,,,,"[t_care_xray_3(1)] = '1'",,,,,,
t_care_us_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_imag_3] = '1'",,,,,,
t_care_us_findings_3,nicu_information_c,,notes,"",,"999 if unknown",,,,,"[t_care_us_3(1)] = '1'",,,,,,
t_care_mri_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_care_imag_3] = '1'",,,,,,
t_care_mri_findings_3,nicu_information_c,,notes,"",,"999 if unknown",,,,,"[t_care_mri_3(1)] = '1'",,,,,,
t_dischargeto_3,nicu_information_c," ",radio,"Discharged from NICU to","1, Home | 2, Hospital | 998, Other | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,,,,,
t_dischargeto_hosp_3,nicu_information_c,,text,"",,,,,,,"[t_dischargeto_3] = '998'",,,,,,
t_meds_desc_3,nicu_information_c,"Infant medications in NICU",descriptive,"Medications given to infant in NICU",,,,,,,"[t_nicu_3] = '1'",,,,,,
t_erythro_3,nicu_information_c,,radio,"Erythromycin (eye prophylaxis)","0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_vitk_3,nicu_information_c,,radio,"Vitamin K","0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_othermeds_3,nicu_information_c,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,"[t_nicu_3] = '1'",,RH,,,,
t_othermeds_s_3,nicu_information_c,,text,"",,,,,,,"[t_othermeds_3] = '1'",,RH,,,,
t_othermeds_ind_3,nicu_information_c,,text,"",,,,,,,"[t_othermeds_3] = '1'",,RH,,,,
t_othermeds_add1_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_othermeds_3] = '1'",,RH,,,,
t_othermeds_s2_3,nicu_information_c,,text,"",,,,,,,"[t_othermeds_add1_3(1)] = '1'",,RH,,,,
t_othermeds_ind2_3,nicu_information_c,,text,"",,,,,,,"[t_othermeds_add1_3(1)] = '1'",,RH,,,,
t_othermeds_add2_3,nicu_information_c,,checkbox,"","1,",,,,,,"[t_othermeds_add1_3(1)] = '1'",,RH,,,,
t_othermeds_s3_3,nicu_information_c,,text,"",,,,,,,"[t_othermeds_add2_3(1)] = '1'",,RH,,,,
t_othermeds_ind3_3,nicu_information_c,,text,"",,,,,,,"[t_othermeds_add2_3(1)] = '1'",,RH,,,,
t_comments_3,nicu_information_c," ",notes,"General comments",,,,,,,,,,,,,
u_done,infant_sarscov2_testing_a,,radio,"Was at least one SARS-COV-2 lab test done in infant?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
u_baby,infant_sarscov2_testing_a,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,"[u_done] = '1'",,RH,,,,
u_naso1,infant_sarscov2_testing_a,,checkbox,"Nasopharyngeal swab #1","1,",,,,,,"[u_done] = '1'",,,,,,
u_naso1_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_naso1(1)] = '1'",,,,,,
u_naso1_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_naso1(1)] = '1'",,,,,,
u_naso1_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_naso1(1)] = '1'",,,,,,
u_naso1_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_naso1(1)] = '1'",,,,,,
u_naso1_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso1(1)] = '1'",,,,,,
u_naso2,infant_sarscov2_testing_a,,checkbox,"Nasopharyngeal swab #2","1,",,,,,,"[u_naso1(1)] = '1'",,,,,,
u_naso2_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_naso2(1)] = '1'",,,,,,
u_naso2_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_naso2(1)] = '1'",,,,,,
u_naso2_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_naso2(1)] = '1'",,,,,,
u_naso2_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_naso2(1)] = '1'",,,,,,
u_naso2_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso2(1)] = '1'",,,,,,
u_naso3,infant_sarscov2_testing_a,,checkbox,"Nasopharyngeal swab #3","1,",,,,,,"[u_naso2(1)] = '1'",,,,,,
u_naso3_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_naso3(1)] = '1'",,,,,,
u_naso3_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_naso3(1)] = '1'",,,,,,
u_naso3_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_naso3(1)] = '1'",,,,,,
u_naso3_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_naso3(1)] = '1'",,,,,,
u_naso3_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso3(1)] = '1'",,,,,,
u_throat,infant_sarscov2_testing_a,,checkbox,"Throat swab","1,",,,,,,"[u_done] = '1'",,,,,,
u_throat_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_throat(1)] = '1'",,,,,,
u_throat_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_throat(1)] = '1'",,,,,,
u_throat_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_throat(1)] = '1'",,,,,,
u_throat_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_throat(1)] = '1'",,,,,,
u_throat_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_throat(1)] = '1'",,,,,,
u_serigm,infant_sarscov2_testing_a,,checkbox,"Serology - IgM","1,",,,,,,"[u_done] = '1'",,,,,,
u_serigm_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_serigm(1)] = '1'",,,,,,
u_serigm_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_serigm(1)] = '1'",,,,,,
u_serigm_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_serigm(1)] = '1'",,,,,,
u_serigm_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_serigm(1)] = '1'",,,,,,
u_serigm_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_serigm(1)] = '1'",,,,,,
u_serigg,infant_sarscov2_testing_a,,checkbox,"Serology - IgG ","1,",,,,,,"[u_done] = '1'",,,,,,
u_serigg_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_serigg(1)] = '1'",,,,,,
u_serigg_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_serigg(1)] = '1'",,,,,,
u_serigg_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_serigg(1)] = '1'",,,,,,
u_serigg_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_serigg(1)] = '1'",,,,,,
u_serigg_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_serigg(1)] = '1'",,,,,,
u_cordigm,infant_sarscov2_testing_a,,checkbox,"Cord blood testing - IgM","1,",,,,,,"[u_done] = '1'",,,,,,
u_cordigm_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_cordigm(1)] = '1'",,,,,,
u_cordigm_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_cordigm(1)] = '1'",,,,,,
u_cordigm_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_cordigm(1)] = '1'",,,,,,
u_cordigm_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_cordigm(1)] = '1'",,,,,,
u_cordigm_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_cordigm(1)] = '1'",,,,,,
u_cordigg,infant_sarscov2_testing_a,,checkbox,"Cord blood testing- IgG","1,",,,,,,"[u_done] = '1'",,,,,,
u_cordigg_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_cordigg(1)] = '1'",,,,,,
u_cordigg_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_cordigg(1)] = '1'",,,,,,
u_cordigg_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_cordigg(1)] = '1'",,,,,,
u_cordigg_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_cordigg(1)] = '1'",,,,,,
u_cordigg_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_cordigg(1)] = '1'",,,,,,
u_other,infant_sarscov2_testing_a,,checkbox,"Other testing, if clinically indicated","1,",,,,,,"[u_done] = '1'",,,,,,
u_other_spec,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_other(1)] = '1'",,,,,,
u_other_collect,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_other(1)] = '1'",,,,,,
u_other_time,infant_sarscov2_testing_a,,text,"",,,time,,,,"[u_other(1)] = '1'",,,,,,
u_other_lab,infant_sarscov2_testing_a,,text,"",,,date_dmy,,,,"[u_other(1)] = '1'",,,,,,
u_other_test,infant_sarscov2_testing_a,,text,"",,"999 if unknown",,,,,"[u_other(1)] = '1'",,,,,,
u_other_res,infant_sarscov2_testing_a,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_other(1)] = '1'",,,,,,
u_done_2,infant_sarscov2_testing_b,,radio,"Was at least one SARS-COV-2 lab test done in infant?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
u_baby_2,infant_sarscov2_testing_b,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,"[u_done_2] = '1'",,RH,,,,
u_naso1_2,infant_sarscov2_testing_b,,checkbox,"Nasopharyngeal swab #1","1,",,,,,,"[u_done_2] = '1'",,,,,,
u_naso1_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_naso1_2(1)] = '1'",,,,,,
u_naso1_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_naso1_2(1)] = '1'",,,,,,
u_naso1_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_naso1_2(1)] = '1'",,,,,,
u_naso1_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_naso1_2(1)] = '1'",,,,,,
u_naso1_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso1_2(1)] = '1'",,,,,,
u_naso2_2,infant_sarscov2_testing_b,,checkbox,"Nasopharyngeal swab #2","1,",,,,,,"[u_naso1_2(1)] = '1'",,,,,,
u_naso2_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_naso2_2(1)] = '1'",,,,,,
u_naso2_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_naso2_2(1)] = '1'",,,,,,
u_naso2_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_naso2_2(1)] = '1'",,,,,,
u_naso2_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_naso2_2(1)] = '1'",,,,,,
u_naso2_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso2_2(1)] = '1'",,,,,,
u_naso3_2,infant_sarscov2_testing_b,,checkbox,"Nasopharyngeal swab #3","1,",,,,,,"[u_naso2_2(1)] = '1'",,,,,,
u_naso3_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_naso3_2(1)] = '1'",,,,,,
u_naso3_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_naso3_2(1)] = '1'",,,,,,
u_naso3_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_naso3_2(1)] = '1'",,,,,,
u_naso3_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_naso3_2(1)] = '1'",,,,,,
u_naso3_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso3_2(1)] = '1'",,,,,,
u_throat_2,infant_sarscov2_testing_b,,checkbox,"Throat swab","1,",,,,,,"[u_done_2] = '1'",,,,,,
u_throat_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_throat_2(1)] = '1'",,,,,,
u_throat_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_throat_2(1)] = '1'",,,,,,
u_throat_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_throat_2(1)] = '1'",,,,,,
u_throat_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_throat_2(1)] = '1'",,,,,,
u_throat_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_throat_2(1)] = '1'",,,,,,
u_serigm_2,infant_sarscov2_testing_b,,checkbox,"Serology - IgM","1,",,,,,,"[u_done_2] = '1'",,,,,,
u_serigm_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_serigm_2(1)] = '1'",,,,,,
u_serigm_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_serigm_2(1)] = '1'",,,,,,
u_serigm_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_serigm_2(1)] = '1'",,,,,,
u_serigm_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_serigm_2(1)] = '1'",,,,,,
u_serigm_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_serigm_2(1)] = '1'",,,,,,
u_serigg_2,infant_sarscov2_testing_b,,checkbox,"Serology - IgG ","1,",,,,,,"[u_done_2] = '1'",,,,,,
u_serigg_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_serigg_2(1)] = '1'",,,,,,
u_serigg_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_serigg_2(1)] = '1'",,,,,,
u_serigg_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_serigg_2(1)] = '1'",,,,,,
u_serigg_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_serigg_2(1)] = '1'",,,,,,
u_serigg_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_serigg_2(1)] = '1'",,,,,,
u_cordigm_2,infant_sarscov2_testing_b,,checkbox,"Cord blood testing - IgM","1,",,,,,,"[u_done_2] = '1'",,,,,,
u_cordigm_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_cordigm_2(1)] = '1'",,,,,,
u_cordigm_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_cordigm_2(1)] = '1'",,,,,,
u_cordigm_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_cordigm_2(1)] = '1'",,,,,,
u_cordigm_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_cordigm_2(1)] = '1'",,,,,,
u_cordigm_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_cordigm_2(1)] = '1'",,,,,,
u_cordigg_2,infant_sarscov2_testing_b,,checkbox,"Cord blood testing- IgG","1,",,,,,,"[u_done_2] = '1'",,,,,,
u_cordigg_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_cordigg_2(1)] = '1'",,,,,,
u_cordigg_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_cordigg_2(1)] = '1'",,,,,,
u_cordigg_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_cordigg_2(1)] = '1'",,,,,,
u_cordigg_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_cordigg_2(1)] = '1'",,,,,,
u_cordigg_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_cordigg_2(1)] = '1'",,,,,,
u_other_2,infant_sarscov2_testing_b,,checkbox,"Other testing, if clinically indicated","1,",,,,,,"[u_done_2] = '1'",,,,,,
u_other_spec_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_other_2(1)] = '1'",,,,,,
u_other_collect_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_other_2(1)] = '1'",,,,,,
u_other_time_2,infant_sarscov2_testing_b,,text,"",,,time,,,,"[u_other_2(1)] = '1'",,,,,,
u_other_lab_2,infant_sarscov2_testing_b,,text,"",,,date_dmy,,,,"[u_other_2(1)] = '1'",,,,,,
u_other_test_2,infant_sarscov2_testing_b,,text,"",,"999 if unknown",,,,,"[u_other_2(1)] = '1'",,,,,,
u_other_res_2,infant_sarscov2_testing_b,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_other_2(1)] = '1'",,,,,,
u_done_3,infant_sarscov2_testing_c,,radio,"Was at least one SARS-COV-2 lab test done in infant?","1, Yes | 0, No | 999, Unknown",,,,,,,,RH,,,,
u_baby_3,infant_sarscov2_testing_c,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,"[u_done_3] = '1'",,RH,,,,
u_naso1_3,infant_sarscov2_testing_c,,checkbox,"Nasopharyngeal swab #1","1,",,,,,,"[u_done_3] = '1'",,,,,,
u_naso1_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_naso1_3(1)] = '1'",,,,,,
u_naso1_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_naso1_3(1)] = '1'",,,,,,
u_naso1_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_naso1_3(1)] = '1'",,,,,,
u_naso1_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_naso1_3(1)] = '1'",,,,,,
u_naso1_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso1_3(1)] = '1'",,,,,,
u_naso2_3,infant_sarscov2_testing_c,,checkbox,"Nasopharyngeal swab #2","1,",,,,,,"[u_naso1_3(1)] = '1'",,,,,,
u_naso2_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_naso2_3(1)] = '1'",,,,,,
u_naso2_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_naso2_3(1)] = '1'",,,,,,
u_naso2_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_naso2_3(1)] = '1'",,,,,,
u_naso2_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_naso2_3(1)] = '1'",,,,,,
u_naso2_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso2_3(1)] = '1'",,,,,,
u_naso3_3,infant_sarscov2_testing_c,,checkbox,"Nasopharyngeal swab #3","1,",,,,,,"[u_naso2_3(1)] = '1'",,,,,,
u_naso3_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_naso3_3(1)] = '1'",,,,,,
u_naso3_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_naso3_3(1)] = '1'",,,,,,
u_naso3_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_naso3_3(1)] = '1'",,,,,,
u_naso3_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_naso3_3(1)] = '1'",,,,,,
u_naso3_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_naso3_3(1)] = '1'",,,,,,
u_throat_3,infant_sarscov2_testing_c,,checkbox,"Throat swab","1,",,,,,,"[u_done_3] = '1'",,,,,,
u_throat_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_throat_3(1)] = '1'",,,,,,
u_throat_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_throat_3(1)] = '1'",,,,,,
u_throat_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_throat_3(1)] = '1'",,,,,,
u_throat_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_throat_3(1)] = '1'",,,,,,
u_throat_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_throat_3(1)] = '1'",,,,,,
u_serigm_3,infant_sarscov2_testing_c,,checkbox,"Serology - IgM","1,",,,,,,"[u_done_3] = '1'",,,,,,
u_serigm_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_serigm_3(1)] = '1'",,,,,,
u_serigm_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_serigm_3(1)] = '1'",,,,,,
u_serigm_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_serigm_3(1)] = '1'",,,,,,
u_serigm_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_serigm_3(1)] = '1'",,,,,,
u_serigm_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_serigm_3(1)] = '1'",,,,,,
u_serigg_3,infant_sarscov2_testing_c,,checkbox,"Serology - IgG ","1,",,,,,,"[u_done_3] = '1'",,,,,,
u_serigg_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_serigg_3(1)] = '1'",,,,,,
u_serigg_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_serigg_3(1)] = '1'",,,,,,
u_serigg_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_serigg_3(1)] = '1'",,,,,,
u_serigg_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_serigg_3(1)] = '1'",,,,,,
u_serigg_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_serigg_3(1)] = '1'",,,,,,
u_cordigm_3,infant_sarscov2_testing_c,,checkbox,"Cord blood testing - IgM","1,",,,,,,"[u_done_3] = '1'",,,,,,
u_cordigm_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_cordigm_3(1)] = '1'",,,,,,
u_cordigm_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_cordigm_3(1)] = '1'",,,,,,
u_cordigm_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_cordigm_3(1)] = '1'",,,,,,
u_cordigm_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_cordigm_3(1)] = '1'",,,,,,
u_cordigm_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_cordigm_3(1)] = '1'",,,,,,
u_cordigg_3,infant_sarscov2_testing_c,,checkbox,"Cord blood testing- IgG","1,",,,,,,"[u_done_3] = '1'",,,,,,
u_cordigg_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_cordigg_3(1)] = '1'",,,,,,
u_cordigg_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_cordigg_3(1)] = '1'",,,,,,
u_cordigg_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_cordigg_3(1)] = '1'",,,,,,
u_cordigg_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_cordigg_3(1)] = '1'",,,,,,
u_cordigg_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_cordigg_3(1)] = '1'",,,,,,
u_other_3,infant_sarscov2_testing_c,,checkbox,"Other testing, if clinically indicated","1,",,,,,,"[u_done_3] = '1'",,,,,,
u_other_spec_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_other_3(1)] = '1'",,,,,,
u_other_collect_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_other_3(1)] = '1'",,,,,,
u_other_time_3,infant_sarscov2_testing_c,,text,"",,,time,,,,"[u_other_3(1)] = '1'",,,,,,
u_other_lab_3,infant_sarscov2_testing_c,,text,"",,,date_dmy,,,,"[u_other_3(1)] = '1'",,,,,,
u_other_test_3,infant_sarscov2_testing_c,,text,"",,"999 if unknown",,,,,"[u_other_3(1)] = '1'",,,,,,
u_other_res_3,infant_sarscov2_testing_c,,radio,"","1, Pos | 0, Neg | 2, Indeterminate | 3, Pending | 999, Unknown",,,,,,"[u_other_3(1)] = '1'",,,,,,
v_date,postpartum_followup_maternal,,text,"Date (records current to)",,,date_dmy,,,,,,,,,,
v_symptoms,postpartum_followup_maternal,,radio,"COVID symptoms postpartum (6-8 weeks)","0, No - asymptomatic | 1, Yes | 999, Unknown",,,,,,,,,,,,
v_onsetdate,postpartum_followup_maternal,,text,"",,,date_dmy,,,,"[v_symptoms] = '1'",,,,,,
v_fever,postpartum_followup_maternal,,radio,Fever,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_fever_temp,postpartum_followup_maternal,,radio,"","1, < 38°C | 2, 38-39C | 3, > 39°C | 999, Unknown",,,,,,"[v_fever] = '1'",,,,,,
v_cough,postpartum_followup_maternal,,radio,Cough,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_head,postpartum_followup_maternal,,radio,Headache,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_breath,postpartum_followup_maternal,,radio,"Shortness of breath","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_runny,postpartum_followup_maternal,,radio,"Runny nose","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_muscle,postpartum_followup_maternal,,radio,"Muscle pain/myalgia","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_anorexia,postpartum_followup_maternal,,radio,"Anorexia (loss of appetite)","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_diarrhea,postpartum_followup_maternal,,radio,Diarrhea,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_vomit,postpartum_followup_maternal,,radio,Vomiting,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_malaise,postpartum_followup_maternal,,radio,Malaise,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_fatigue,postpartum_followup_maternal,,radio,Fatigue,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_anosmia,postpartum_followup_maternal,,radio,"Anosmia or ageusia (loss of smell or taste)","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_throat,postpartum_followup_maternal,,radio,"Sore throat","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_sputum,postpartum_followup_maternal,,radio,"Sputum production","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_nausea,postpartum_followup_maternal,,radio,Nausea,"0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_resp,postpartum_followup_maternal,,radio,"Non-specific respiratory symptoms","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_othersx,postpartum_followup_maternal,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_othersx_spec,postpartum_followup_maternal,,text,"",,"999 if unknown",,,,,"[v_othersx] = '1'",,RH,,,,
v_othersx_2,postpartum_followup_maternal,,radio,"Other Sx","0, No | 1, Yes | 999, Unknown",,,,,,"[v_symptoms] = '1'",,RH,,,,
v_othersx_spec_2,postpartum_followup_maternal,,text,"",,"999 if unknown",,,,,"[v_othersx_2] = '1'",,RH,,,,
v_issues,postpartum_followup_maternal," ",checkbox,"Any maternal health issues since delivery? ","0, No | 1, Postpartum depression | 2, Wound infection | 3, Postpartum preeclampsia | 4, Endometritis | 998, Other | 999, Unknown",,,,,,,,LV,,,,
v_issues_des,postpartum_followup_maternal,,notes,"",,"999 if unknown",,,,,"[v_issues(998)] = '1'",,RH,,,,
v_desc,postpartum_followup_maternal,,descriptive,"NOTES:
*Please update the SARS-COV-2 HISTORY, MATERNAL TESTING, SYMPTOMS, TREATMENTS, & HOSPITALIZATONS THROUGH FOLLOW-UP form as applicable: COVID symptoms, complications, imaging, treatments
**Record maternal COVID-19 medications since discharge (or last report if home birth) below
***If additional infant SARS-CoV-2 testing or maternal SARS-CoV-2 testing is done, please update SARS-CoV-2 DCFs on the maternal testing forms and the infant testing forms
",,,,,,,,,,,,,
w_desc,postpartum_medications_for_covid_since_discharge_m,,descriptive,"NOTE: Record other medications on General Medications form
",,,,,,,,,,,,,
w_otc_none,postpartum_medications_for_covid_since_discharge_m,"Over the counter medications",radio,,"0, No over the counter medications | 999, Unknown",,,,,,,,LH,,,,
w_otc,postpartum_medications_for_covid_since_discharge_m,,checkbox,"OTC meds","1,",,,,,,"[w_otc_none] = ''",,,,,,
w_otc_aceta,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_otc(1)] = '1'",,,,,,
w_otc_nsaids,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_otc(1)] = '1'",,,,,,
w_otc_nsaids_asp,postpartum_medications_for_covid_since_discharge_m,,checkbox,"Acetylsalicylic acid (Aspirin)
","1,",,,,,,"[w_otc_nsaids(1)] = '1'",,,,,,
w_otc_nsaids_ibu,postpartum_medications_for_covid_since_discharge_m,,checkbox,"Ibuprofen (Advil, Motrin, others)
","1,",,,,,,"[w_otc_nsaids(1)] = '1'",,,,,,
w_otc_nsaids_nap,postpartum_medications_for_covid_since_discharge_m,,checkbox,"Naproxen (Aleve, Naprosyn, other)
","1,",,,,,,"[w_otc_nsaids(1)] = '1'",,,,,,
w_otc_nsaids_oth,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_otc_nsaids(1)] = '1'",,,,,,
w_otc_nsaids_oth_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_otc_nsaids_oth(1)] = '1'",,,,,,
w_otc_nsaids_oth_2,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_otc_nsaids_oth(1)] = '1'",,,,,,
w_otc_nsaids_oth_s_2,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_otc_nsaids_oth_2(1)] = '1'",,,,,,
w_otc_oth1,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_otc(1)] = '1'",,,,,,
w_otc_oth1_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_otc_oth1(1)] = '1'",,,,,,
w_otc_oth2,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_otc(1)] = '1' and [w_otc_oth1(1)] = '1'",,,,,,
w_otc_oth2_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_otc_oth2(1)] = '1'",,,,,,
w_otc_oth3,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_otc(1)] = '1' and [w_otc_oth2(1)] = '1'",,,,,,
w_otc_oth3_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_otc_oth3(1)] = '1'",,,,,,
w_pres_none,postpartum_medications_for_covid_since_discharge_m,"Prescription medications",radio,,"0, No prescription medications | 999, Unknown",,,,,,,,LH,,,,
w_pres_cort,postpartum_medications_for_covid_since_discharge_m,,checkbox,"Corticosteroids (check all taken)
","1,",,,,,,"[w_pres_none] = ''",,,,,,
w_pres_cort_dex,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_cort(1)] = '1'",,,,,,
w_pres_cort_dex_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_cort_dex(1)] = '1'",,,,,,
w_pres_cort_dex_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_dex(1)] = '1'",,,,,,
w_pres_cort_dex_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_dex(1)] = '1'",,,,,,
w_pres_cort_oth,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_cort(1)] = '1'",,,,,,
w_pres_cort_oth_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_oth(1)] = '1'",,,,,,
w_pres_cort_oth_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_cort_oth(1)] = '1'",,,,,,
w_pres_cort_oth_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_oth(1)] = '1'",,,,,,
w_pres_cort_oth_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_oth(1)] = '1'",,,,,,
w_pres_cort_oth_2,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_cort_oth(1)] = '1'",,,,,,
w_pres_cort_oth_s_2,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_oth_2(1)] = '1'",,,,,,
w_pres_cort_oth_ct_2,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_cort_oth_2(1)] = '1'",,,,,,
w_pres_cort_oth_dose_2,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_oth_2(1)] = '1'",,,,,,
w_pres_cort_oth_dur_2,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_cort_oth_2(1)] = '1'",,,,,,
w_pres_chlor,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_none] = ''",,,,,,
w_pres_chlor_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_chlor(1)] = '1'",,,,,,
w_pres_chlor_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_chlor(1)] = '1'",,,,,,
w_pres_chlor_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_chlor(1)] = '1'",,,,,,
w_pres_chlor_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_chlor(1)] = '1'",,,,,,
w_pres_hydrox,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_none] = ''",,,,,,
w_pres_hydrox_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_hydrox(1)] = '1'",,,,,,
w_pres_hydrox_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_hydrox(1)] = '1'",,,,,,
w_pres_hydrox_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_hydrox(1)] = '1'",,,,,,
w_pres_hydrox_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_hydrox(1)] = '1'",,,,,,
w_pres_colch,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_none] = ''",,,,,,
w_pres_colch_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_colch(1)] = '1'",,,,,,
w_pres_colch_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_colch(1)] = '1'",,,,,,
w_pres_colch_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_colch(1)] = '1'",,,,,,
w_pres_av,postpartum_medications_for_covid_since_discharge_m,,checkbox," Antiviral (check all taken)
","1,",,,,,,"[w_pres_none] = ''",,,,,,
w_pres_av_kal,postpartum_medications_for_covid_since_discharge_m,,checkbox,"Kaletra (Lopinavir/Ritonavir)
","1,",,,,,,"[w_pres_av(1)] = '1'",,,,,,
w_pres_av_kal_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_av_kal(1)] = '1'",,,,,,
w_pres_av_kal_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_kal(1)] = '1'",,,,,,
w_pres_av_kal_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_kal(1)] = '1'",,,,,,
w_pres_av_rem,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_av(1)] = '1'",,,,,,
w_pres_av_rem_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_av_rem(1)] = '1'",,,,,,
w_pres_av_rem_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_rem(1)] = '1'",,,,,,
w_pres_av_rem_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_rem(1)] = '1'",,,,,,
w_pres_av_oth1,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_av(1)] = '1'",,,,,,
w_pres_av_oth1_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_oth1(1)] = '1'",,,,,,
w_pres_av_oth1_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_av_oth1(1)] = '1'",,,,,,
w_pres_av_oth1_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_oth1(1)] = '1'",,,,,,
w_pres_av_oth1_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_oth1(1)] = '1'",,,,,,
w_pres_av_oth2,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_av_oth1(1)] = '1'",,,,,,
w_pres_av_oth2_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_oth2(1)] = '1'",,,,,,
w_pres_av_oth2_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_av_oth2(1)] = '1'",,,,,,
w_pres_av_oth2_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_oth2(1)] = '1'",,,,,,
w_pres_av_oth2_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_av_oth2(1)] = '1'",,,,,,
w_pres_ab,postpartum_medications_for_covid_since_discharge_m,,checkbox,"Antibiotics (check all taken)
","1,",,,,,,"[w_pres_none] = ''",,,,,,
w_pres_ab_s1,postpartum_medications_for_covid_since_discharge_m,,text,"",,,,,,,"[w_pres_ab(1)] = '1'",,,,,,
w_pres_ab_1_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_ab_s1] <> ''",,,,,,
w_pres_ab_1_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_ab_s1] <> ''",,,,,,
w_pres_ab_1_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_ab_s1] <> ''",,,,,,
w_pres_ab_s2,postpartum_medications_for_covid_since_discharge_m,,text,"",,,,,,,"[w_pres_ab_s1] <> ''",,,,,,
w_pres_ab_2_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_ab_s2] <> ''",,,,,,
w_pres_ab_2_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_ab_s2] <> ''",,,,,,
w_pres_ab_2_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_ab_s2] <> ''",,,,,,
w_pres_oth1,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_none] = ''",,,,,,
w_pres_oth1_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth1(1)] = '1'",,,,,,
w_pres_oth1_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth1(1)] = '1'",,,,,,
w_pres_oth1_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth1(1)] = '1'",,,,,,
w_pres_oth1_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth1(1)] = '1'",,,,,,
w_pres_oth2,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth1(1)] = '1'",,,,,,
w_pres_oth2_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth2(1)] = '1'",,,,,,
w_pres_oth2_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth2(1)] = '1'",,,,,,
w_pres_oth2_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth2(1)] = '1'",,,,,,
w_pres_oth2_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth2(1)] = '1'",,,,,,
w_pres_oth3,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth2(1)] = '1'",,,,,,
w_pres_oth3_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth3(1)] = '1'",,,,,,
w_pres_oth3_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth3(1)] = '1'",,,,,,
w_pres_oth3_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth3(1)] = '1'",,,,,,
w_pres_oth3_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth3(1)] = '1'",,,,,,
w_pres_oth4,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth3(1)] = '1'",,,,,,
w_pres_oth4_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth4(1)] = '1'",,,,,,
w_pres_oth4_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth4(1)] = '1'",,,,,,
w_pres_oth4_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth4(1)] = '1'",,,,,,
w_pres_oth4_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth4(1)] = '1'",,,,,,
w_pres_oth5,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth4(1)] = '1'",,,,,,
w_pres_oth5_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth5(1)] = '1'",,,,,,
w_pres_oth5_ct,postpartum_medications_for_covid_since_discharge_m,,checkbox,"","1,",,,,,,"[w_pres_oth5(1)] = '1'",,,,,,
w_pres_oth5_dose,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth5(1)] = '1'",,,,,,
w_pres_oth5_dur,postpartum_medications_for_covid_since_discharge_m,,text,"",,"999 if unknown",,,,,"[w_pres_oth5(1)] = '1'",,,,,,
w_nat_none,postpartum_medications_for_covid_since_discharge_m,"Natural Health Products",radio,,"0, No natural health products | 999, Unknown",,,,,,,,LH,,,,
w_nat,postpartum_medications_for_covid_since_discharge_m,,checkbox,"Natural health products","1,",,,,,,"[w_nat_none] = ''",,,,,,
w_nat1_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,,,,,,"[w_nat(1)] = '1'",,,,,,
w_nat2_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,,,,,,"[w_nat1_s] <> ''",,,,,,
w_nat3_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,,,,,,"[w_nat2_s] <> ''",,,,,,
w_nat4_s,postpartum_medications_for_covid_since_discharge_m,,text,"",,,,,,,"[w_nat3_s] <> ''",,,,,,
w_comments,postpartum_medications_for_covid_since_discharge_m," ",notes,"General comments",,,,,,,,,,,,,
x_baby,postpartum_followup_infant_a,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
x_wtgain,postpartum_followup_infant_a,"Any infant health events / issues since discharge (last report for home births without admission)",radio,"Poor weight gain","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_wtgain_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_wtgain] = '1'",,RH,,,,
x_seizures,postpartum_followup_infant_a,,radio,"Seizures/ on antiepileptic medications ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_seizures_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_seizures] = '1'",,RH,,,,
x_bronchiolitis,postpartum_followup_infant_a,,radio,Bronchiolitis,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_bronchiolitis_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_bronchiolitis] = '1'",,RH,,,,
x_constipation,postpartum_followup_infant_a,,radio,Constipation,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_constipation_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_constipation] = '1'",,RH,,,,
x_pneumonia,postpartum_followup_infant_a,,radio,Pneumonia,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_pneumonia_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_pneumonia] = '1'",,RH,,,,
x_rehosp,postpartum_followup_infant_a,,radio,Rehospitalization,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_rehosp_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_rehosp] = '1'",,RH,,,,
x_relapse,postpartum_followup_infant_a,,radio,"Acquire or relapse of COVID after discharge ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_relapse_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_relapse] = '1'",,RH,,,,
x_death,postpartum_followup_infant_a,,radio,"Infant death","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_death_desc,postpartum_followup_infant_a,,descriptive,"Complete infant death formÂ
",,,,,,,"[x_death] = '1'",,,,,,
x_other,postpartum_followup_infant_a,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_other_des,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_other] = '1'",,RH,,,,
x_feed_bf,postpartum_followup_infant_a,"Type of feeding to date",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
x_feed_express,postpartum_followup_infant_a,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed,,
x_feed_formula,postpartum_followup_infant_a,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed,,
x_feed_donor,postpartum_followup_infant_a,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed,,
x_feed_iv,postpartum_followup_infant_a,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed,,
x_med,postpartum_followup_infant_a,"Infant medications",radio,"Medications given to infant","1, Yes | 0, No | 999, Unknown",,,,,,,,LH,,,,
x_med1,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med] = '1'",,RH,,,,
x_med1_ind,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med] = '1'",,RH,,,,
x_med2,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med1] <> ''",,RH,,,,
x_med2_ind,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med1] <> ''",,RH,,,,
x_med3,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med2] <> ''",,RH,,,,
x_med3_ind,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med2] <> ''",,RH,,,,
x_med4,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med3] <> ''",,RH,,,,
x_med4_ind,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med3] <> ''",,RH,,,,
x_med5,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med4] <> ''",,RH,,,,
x_med5_ind,postpartum_followup_infant_a,,text,"",,"999 if unknown",,,,,"[x_med4] <> ''",,RH,,,,
x_comments,postpartum_followup_infant_a," ",notes,"General comments",,,,,,,,,,,,,
x_baby_2,postpartum_followup_infant_b,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
x_wtgain_2,postpartum_followup_infant_b,"Any infant health events / issues since discharge (last report for home births without admission)",radio,"Poor weight gain","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_wtgain_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_wtgain_2] = '1'",,RH,,,,
x_seizures_2,postpartum_followup_infant_b,,radio,"Seizures/ on antiepileptic medications ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_seizures_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_seizures_2] = '1'",,RH,,,,
x_bronchiolitis_2,postpartum_followup_infant_b,,radio,Bronchiolitis,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_bronchiolitis_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_bronchiolitis_2] = '1'",,RH,,,,
x_constipation_2,postpartum_followup_infant_b,,radio,Constipation,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_constipation_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_constipation_2] = '1'",,RH,,,,
x_pneumonia_2,postpartum_followup_infant_b,,radio,Pneumonia,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_pneumonia_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_pneumonia_2] = '1'",,RH,,,,
x_rehosp_2,postpartum_followup_infant_b,,radio,Rehospitalization,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_rehosp_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_rehosp_2] = '1'",,RH,,,,
x_relapse_2,postpartum_followup_infant_b,,radio,"Acquire or relapse of COVID after discharge ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_relapse_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_relapse_2] = '1'",,RH,,,,
x_death_2,postpartum_followup_infant_b,,radio,"Infant death","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_death_desc_2,postpartum_followup_infant_b,,descriptive,"Complete infant death formÂ
",,,,,,,"[x_death_2] = '1'",,,,,,
x_other_2,postpartum_followup_infant_b,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_other_des_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_other_2] = '1'",,RH,,,,
x_feed_bf_2,postpartum_followup_infant_b,"Type of feeding to date",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
x_feed_express_2,postpartum_followup_infant_b,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_2,,
x_feed_formula_2,postpartum_followup_infant_b,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_2,,
x_feed_donor_2,postpartum_followup_infant_b,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_2,,
x_feed_iv_2,postpartum_followup_infant_b,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_2,,
x_med_2,postpartum_followup_infant_b,"Infant medications",radio,"Medications given to infant","1, Yes | 0, No | 999, Unknown",,,,,,,,LH,,,,
x_med1_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med_2] = '1'",,RH,,,,
x_med1_ind_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med_2] = '1'",,RH,,,,
x_med2_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med1_2] <> ''",,RH,,,,
x_med2_ind_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med1_2] <> ''",,RH,,,,
x_med3_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med2_2] <> ''",,RH,,,,
x_med3_ind_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med2_2] <> ''",,RH,,,,
x_med4_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med3_2] <> ''",,RH,,,,
x_med4_ind_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med3_2] <> ''",,RH,,,,
x_med5_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med4_2] <> ''",,RH,,,,
x_med5_ind_2,postpartum_followup_infant_b,,text,"",,"999 if unknown",,,,,"[x_med4_2] <> ''",,RH,,,,
x_comments_2,postpartum_followup_infant_b," ",notes,"General comments",,,,,,,,,,,,,
x_baby_3,postpartum_followup_infant_c,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
x_wtgain_3,postpartum_followup_infant_c,"Any infant health events / issues since discharge (last report for home births without admission)",radio,"Poor weight gain","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_wtgain_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_wtgain_3] = '1'",,RH,,,,
x_seizures_3,postpartum_followup_infant_c,,radio,"Seizures/ on antiepileptic medications ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_seizures_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_seizures_3] = '1'",,RH,,,,
x_bronchiolitis_3,postpartum_followup_infant_c,,radio,Bronchiolitis,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_bronchiolitis_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_bronchiolitis_3] = '1'",,RH,,,,
x_constipation_3,postpartum_followup_infant_c,,radio,Constipation,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_constipation_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_constipation_3] = '1'",,RH,,,,
x_pneumonia_3,postpartum_followup_infant_c,,radio,Pneumonia,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_pneumonia_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_pneumonia_3] = '1'",,RH,,,,
x_rehosp_3,postpartum_followup_infant_c,,radio,Rehospitalization,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_rehosp_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_rehosp_3] = '1'",,RH,,,,
x_relapse_3,postpartum_followup_infant_c,,radio,"Acquire or relapse of COVID after discharge ","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_relapse_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_relapse_3] = '1'",,RH,,,,
x_death_3,postpartum_followup_infant_c,,radio,"Infant death","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_death_desc_3,postpartum_followup_infant_c,,descriptive,"Complete infant death formÂ
",,,,,,,"[x_death_3] = '1'",,,,,,
x_other_3,postpartum_followup_infant_c,,radio,Other,"0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
x_other_des_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_other_3] = '1'",,RH,,,,
x_feed_bf_3,postpartum_followup_infant_c,"Type of feeding to date",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
x_feed_express_3,postpartum_followup_infant_c,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_3,,
x_feed_formula_3,postpartum_followup_infant_c,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_3,,
x_feed_donor_3,postpartum_followup_infant_c,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_3,,
x_feed_iv_3,postpartum_followup_infant_c,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_3,,
x_med_3,postpartum_followup_infant_c,"Infant medications",radio,"Medications given to infant","1, Yes | 0, No | 999, Unknown",,,,,,,,LH,,,,
x_med1_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med_3] = '1'",,RH,,,,
x_med1_ind_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med_3] = '1'",,RH,,,,
x_med2_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med1_3] <> ''",,RH,,,,
x_med2_ind_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med1_3] <> ''",,RH,,,,
x_med3_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med2_3] <> ''",,RH,,,,
x_med3_ind_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med2_3] <> ''",,RH,,,,
x_med4_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med3_3] <> ''",,RH,,,,
x_med4_ind_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med3_3] <> ''",,RH,,,,
x_med5_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med4_3] <> ''",,RH,,,,
x_med5_ind_3,postpartum_followup_infant_c,,text,"",,"999 if unknown",,,,,"[x_med4_3] <> ''",,RH,,,,
x_comments_3,postpartum_followup_infant_c," ",notes,"General comments",,,,,,,,,,,,,
y_date,one_year_infant_followup_a,,text,"Date (records current to)",,,date_dmy,,,,,,,,,,
y_baby,one_year_infant_followup_a,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
y_weightgain,one_year_infant_followup_a,,radio,"Poor weight gain / failure-to-thrive","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_weightgain_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_weightgain] = '1'",,RH,,,,
y_anaphylaxis,one_year_infant_followup_a,,radio,Anaphylaxis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_anaphylaxis_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_anaphylaxis] = '1'",,RH,,,,
y_rhinitis,one_year_infant_followup_a,,radio,"Allergic rhinitis","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_rhinitis_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_rhinitis] = '1'",,RH,,,,
y_kawasaki,one_year_infant_followup_a,,radio,"Kawasaki disease","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_kawasaki_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_kawasaki] = '1'",,RH,,,,
y_asthma,one_year_infant_followup_a,,radio,Asthma,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_asthma_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_asthma] = '1'",,RH,,,,
y_oxygen,one_year_infant_followup_a,,radio,"Need for home oxygen for any duration","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_oxygen_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_oxygen] = '1'",,RH,,,,
y_dm,one_year_infant_followup_a,,radio,"Diabetes mellitus ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_dm_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_dm] = '1'",,RH,,,,
y_hypothy,one_year_infant_followup_a,,radio,Hypothyroidism,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hypothy_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_hypothy] = '1'",,RH,,,,
y_renalfail,one_year_infant_followup_a,,radio,"Renal failure requiring replacement therapy","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_renalfail_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_renalfail] = '1'",,RH,,,,
y_htn,one_year_infant_followup_a,,radio,Hypertension,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_htn_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_htn] = '1'",,RH,,,,
y_glom,one_year_infant_followup_a,,radio,Glomerulonephritis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_glom_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_glom] = '1'",,RH,,,,
y_uti,one_year_infant_followup_a,,radio,"Urinary tract infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_uti_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_uti] = '1'",,RH,,,,
y_bacteremia,one_year_infant_followup_a,,radio,"Culture proven bacteremia","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bacteremia_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_bacteremia] = '1'",,RH,,,,
y_meningitis,one_year_infant_followup_a,,radio,Meningitis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_meningitis_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_meningitis] = '1'",,RH,,,,
y_otitis,one_year_infant_followup_a,,radio,"Otitis media","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_otitis_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_otitis] = '1'",,RH,,,,
y_bronchitis,one_year_infant_followup_a,,radio,"Acute bronchitis","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bronchitis_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_bronchitis] = '1'",,RH,,,,
y_bronchio,one_year_infant_followup_a,,radio,"Acute bronchiolitis ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bronchio_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_bronchio] = '1'",,RH,,,,
y_pneumonia,one_year_infant_followup_a,,radio,"Pneumonia, any organism","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_pneumonia_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_pneumonia] = '1'",,RH,,,,
y_upperresp,one_year_infant_followup_a,,radio,"Upper respiratory infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_upperresp_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_upperresp] = '1'",,RH,,,,
y_ecoli,one_year_infant_followup_a,,radio,"Any infection caused by Escherichia coli","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_ecoli_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_ecoli] = '1'",,RH,,,,
y_hinf,one_year_infant_followup_a,,radio,"Any infection caused by Haemophilus influenzae","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hinf_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_hinf] = '1'",,RH,,,,
y_kpneu,one_year_infant_followup_a,,radio,"Any infection caused by Klebsiella pneumoniae","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_kpneu_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_kpneu] = '1'",,RH,,,,
y_strep,one_year_infant_followup_a,,radio,"Any infection caused by Streptococcus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_strep_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_strep] = '1'",,RH,,,,
y_staph,one_year_infant_followup_a,,radio,"Any infection caused by Staphylococcus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_staph_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_staph] = '1'",,RH,,,,
y_entero,one_year_infant_followup_a,,radio,"Enterovirus infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_entero_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_entero] = '1'",,RH,,,,
y_gastro,one_year_infant_followup_a,,radio,"Gastroenteritis ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_gastro_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_gastro] = '1'",,RH,,,,
y_constipation,one_year_infant_followup_a,,radio,Constipation,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_constipation_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_constipation] = '1'",,RH,,,,
y_hfm,one_year_infant_followup_a,,radio,"Hand-Foot-and-Mouth Disease","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hfm_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_hfm] = '1'",,RH,,,,
y_hsv,one_year_infant_followup_a,,radio,"Herpes simplex","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hsv_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_hsv] = '1'",,RH,,,,
y_syncytical,one_year_infant_followup_a,,radio,"Respiratory syncytical virus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_syncytical_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_syncytical] = '1'",,RH,,,,
y_varicella,one_year_infant_followup_a,,radio,"Varicella (chickenpox)","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_varicella_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_varicella] = '1'",,RH,,,,
y_seizures,one_year_infant_followup_a,,radio,"Seizures/ on antiepileptic medications ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_seizures_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_seizures] = '1'",,RH,,,,
y_rehosp,one_year_infant_followup_a,,radio,Rehospitalization,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_rehosp_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_rehosp] = '1'",,RH,,,,
y_covid,one_year_infant_followup_a,,radio,"Acquire or relapse of COVID after 6-8 week follow-up?","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_covid_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_covid] = '1'",,RH,,,,
y_death,one_year_infant_followup_a,,radio,"Infant death","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_death_desc,one_year_infant_followup_a,,descriptive,"Please complete infant death form
",,,,,,,"[y_death] = '1'",,,,,,
y_other,one_year_infant_followup_a,,radio,Other,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other_des,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_other] = '1'",,RH,,,,
y_feed_bf,one_year_infant_followup_a,"Type of feeding to date",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
y_feed_express,one_year_infant_followup_a,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa,,
y_feed_formula,one_year_infant_followup_a,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa,,
y_feed_donor,one_year_infant_followup_a,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa,,
y_feed_iv,one_year_infant_followup_a,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa,,
y_antihis,one_year_infant_followup_a,"Infant medications",radio,"Antihistamine
(Examples: Atarax (hydroxyzine); Reactine (cetirizine); Rupall (rupadtadine); Blexten (bilastine))
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antihis_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_antihis] = '1'",,RH,,,,
y_antihis_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antihis] = '1'",,,,,,
y_betaag,one_year_infant_followup_a,,radio,"Beta-agonists or inhaled bronchodilators
(Examples: Ventolin (salbutamol); Bricanyl (terbutaline))
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_betaag_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_betaag] = '1'",,RH,,,,
y_betaag_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_betaag] = '1'",,,,,,
y_inhaledcs,one_year_infant_followup_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_inhaledcs_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_inhaledcs] = '1'",,RH,,,,
y_inhaledcs_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_inhaledcs] = '1'",,,,,,
y_intranasalcs,one_year_infant_followup_a,,radio,"Intranasal corticosteroids
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_intranasalcs_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_intranasalcs] = '1'",,RH,,,,
y_intranasalcs_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_intranasalcs] = '1'",,,,,,
y_systemiccs,one_year_infant_followup_a,,radio,"Systemic corticosteroids
(Examples: dexamethasone, prednisone, hydrocortisone)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_systemiccs_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_systemiccs] = '1'",,RH,,,,
y_systemiccs_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_systemiccs] = '1'",,,,,,
y_endocrinemeds,one_year_infant_followup_a,,radio,"Any medications for endocrine-related disorders
(Examples: Desmopressin, Diazoxide, Glucagon, Growth hormone, Insulin, Lupron, Octreotide, Testosterone, Thyroxine)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_endocrinemeds_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_endocrinemeds] = '1'",,RH,,,,
y_endocrinemeds_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_endocrinemeds] = '1'",,,,,,
y_antihyperten,one_year_infant_followup_a,,radio,"Any anti-hypertensive medication
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antihyperten_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_antihyperten] = '1'",,RH,,,,
y_antihyperten_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antihyperten] = '1'",,,,,,
y_antibiotics,one_year_infant_followup_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antibiotics_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_antibiotics] = '1'",,RH,,,,
y_antibiotics_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antibiotics] = '1'",,,,,,
y_probiotics,one_year_infant_followup_a,,radio,"Any probiotics (prescribed or over-the-counter)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_probiotics_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_probiotics] = '1'",,RH,,,,
y_probiotics_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_probiotics] = '1'",,,,,,
y_other1,one_year_infant_followup_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other1_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_other1] = '1'",,RH,,,,
y_other1_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_other1] = '1'",,,,,,
y_other2,one_year_infant_followup_a,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other2_s,one_year_infant_followup_a,,text,"",,"999 if unknown",,,,,"[y_other2] = '1'",,RH,,,,
y_other2_dur,one_year_infant_followup_a,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_other2] = '1'",,,,,,
y_comments,one_year_infant_followup_a," ",notes,"General comments",,,,,,,,,,,,,
y_date_2,one_year_infant_followup_b,,text,"Date (records current to)",,,date_dmy,,,,,,,,,,
y_baby_2,one_year_infant_followup_b,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
y_weightgain_2,one_year_infant_followup_b,,radio,"Poor weight gain / failure-to-thrive","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_weightgain_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_weightgain_2] = '1'",,RH,,,,
y_anaphylaxis_2,one_year_infant_followup_b,,radio,Anaphylaxis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_anaphylaxis_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_anaphylaxis_2] = '1'",,RH,,,,
y_rhinitis_2,one_year_infant_followup_b,,radio,"Allergic rhinitis","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_rhinitis_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_rhinitis_2] = '1'",,RH,,,,
y_kawasaki_2,one_year_infant_followup_b,,radio,"Kawasaki disease","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_kawasaki_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_kawasaki_2] = '1'",,RH,,,,
y_asthma_2,one_year_infant_followup_b,,radio,Asthma,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_asthma_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_asthma_2] = '1'",,RH,,,,
y_oxygen_2,one_year_infant_followup_b,,radio,"Need for home oxygen for any duration","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_oxygen_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_oxygen_2] = '1'",,RH,,,,
y_dm_2,one_year_infant_followup_b,,radio,"Diabetes mellitus ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_dm_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_dm_2] = '1'",,RH,,,,
y_hypothy_2,one_year_infant_followup_b,,radio,Hypothyroidism,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hypothy_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_hypothy_2] = '1'",,RH,,,,
y_renalfail_2,one_year_infant_followup_b,,radio,"Renal failure requiring replacement therapy","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_renalfail_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_renalfail_2] = '1'",,RH,,,,
y_htn_2,one_year_infant_followup_b,,radio,Hypertension,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_htn_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_htn_2] = '1'",,RH,,,,
y_glom_2,one_year_infant_followup_b,,radio,Glomerulonephritis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_glom_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_glom_2] = '1'",,RH,,,,
y_uti_2,one_year_infant_followup_b,,radio,"Urinary tract infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_uti_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_uti_2] = '1'",,RH,,,,
y_bacteremia_2,one_year_infant_followup_b,,radio,"Culture proven bacteremia","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bacteremia_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_bacteremia_2] = '1'",,RH,,,,
y_meningitis_2,one_year_infant_followup_b,,radio,Meningitis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_meningitis_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_meningitis_2] = '1'",,RH,,,,
y_otitis_2,one_year_infant_followup_b,,radio,"Otitis media","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_otitis_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_otitis_2] = '1'",,RH,,,,
y_bronchitis_2,one_year_infant_followup_b,,radio,"Acute bronchitis","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bronchitis_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_bronchitis_2] = '1'",,RH,,,,
y_bronchio_2,one_year_infant_followup_b,,radio,"Acute bronchiolitis ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bronchio_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_bronchio_2] = '1'",,RH,,,,
y_pneumonia_2,one_year_infant_followup_b,,radio,"Pneumonia, any organism","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_pneumonia_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_pneumonia_2] = '1'",,RH,,,,
y_upperresp_2,one_year_infant_followup_b,,radio,"Upper respiratory infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_upperresp_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_upperresp_2] = '1'",,RH,,,,
y_ecoli_2,one_year_infant_followup_b,,radio,"Any infection caused by Escherichia coli","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_ecoli_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_ecoli_2] = '1'",,RH,,,,
y_hinf_2,one_year_infant_followup_b,,radio,"Any infection caused by Haemophilus influenzae","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hinf_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_hinf_2] = '1'",,RH,,,,
y_kpneu_2,one_year_infant_followup_b,,radio,"Any infection caused by Klebsiella pneumoniae","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_kpneu_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_kpneu_2] = '1'",,RH,,,,
y_strep_2,one_year_infant_followup_b,,radio,"Any infection caused by Streptococcus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_strep_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_strep_2] = '1'",,RH,,,,
y_staph_2,one_year_infant_followup_b,,radio,"Any infection caused by Staphylococcus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_staph_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_staph_2] = '1'",,RH,,,,
y_entero_2,one_year_infant_followup_b,,radio,"Enterovirus infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_entero_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_entero_2] = '1'",,RH,,,,
y_gastro_2,one_year_infant_followup_b,,radio,"Gastroenteritis ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_gastro_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_gastro_2] = '1'",,RH,,,,
y_constipation_2,one_year_infant_followup_b,,radio,Constipation,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_constipation_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_constipation_2] = '1'",,RH,,,,
y_hfm_2,one_year_infant_followup_b,,radio,"Hand-Foot-and-Mouth Disease","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hfm_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_hfm_2] = '1'",,RH,,,,
y_hsv_2,one_year_infant_followup_b,,radio,"Herpes simplex","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hsv_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_hsv_2] = '1'",,RH,,,,
y_syncytical_2,one_year_infant_followup_b,,radio,"Respiratory syncytical virus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_syncytical_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_syncytical_2] = '1'",,RH,,,,
y_varicella_2,one_year_infant_followup_b,,radio,"Varicella (chickenpox)","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_varicella_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_varicella_2] = '1'",,RH,,,,
y_seizures_2,one_year_infant_followup_b,,radio,"Seizures/ on antiepileptic medications ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_seizures_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_seizures_2] = '1'",,RH,,,,
y_rehosp_2,one_year_infant_followup_b,,radio,Rehospitalization,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_rehosp_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_rehosp_2] = '1'",,RH,,,,
y_covid_2,one_year_infant_followup_b,,radio,"Acquire or relapse of COVID after 6-8 week follow-up?","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_covid_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_covid_2] = '1'",,RH,,,,
y_death_2,one_year_infant_followup_b,,radio,"Infant death","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_death_desc_2,one_year_infant_followup_b,,descriptive,"Please complete infant death form
",,,,,,,"[y_death_2] = '1'",,,,,,
y_other_2,one_year_infant_followup_b,,radio,Other,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other_des_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_other_2] = '1'",,RH,,,,
y_feed_bf_2,one_year_infant_followup_b,"Type of feeding to date",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
y_feed_express_2,one_year_infant_followup_b,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_2,,
y_feed_formula_2,one_year_infant_followup_b,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_2,,
y_feed_donor_2,one_year_infant_followup_b,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_2,,
y_feed_iv_2,one_year_infant_followup_b,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_2,,
y_antihis_2,one_year_infant_followup_b,"Infant medications",radio,"Antihistamine
(Examples: Atarax (hydroxyzine); Reactine (cetirizine); Rupall (rupadtadine); Blexten (bilastine))
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antihis_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_antihis_2] = '1'",,RH,,,,
y_antihis_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antihis_2] = '1'",,,,,,
y_betaag_2,one_year_infant_followup_b,,radio,"Beta-agonists or inhaled bronchodilators
(Examples: Ventolin (salbutamol); Bricanyl (terbutaline))
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_betaag_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_betaag_2] = '1'",,RH,,,,
y_betaag_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_betaag_2] = '1'",,,,,,
y_inhaledcs_2,one_year_infant_followup_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_inhaledcs_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_inhaledcs_2] = '1'",,RH,,,,
y_inhaledcs_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_inhaledcs_2] = '1'",,,,,,
y_intranasalcs_2,one_year_infant_followup_b,,radio,"Intranasal corticosteroids
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_intranasalcs_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_intranasalcs_2] = '1'",,RH,,,,
y_intranasalcs_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_intranasalcs_2] = '1'",,,,,,
y_systemiccs_2,one_year_infant_followup_b,,radio,"Systemic corticosteroids
(Examples: dexamethasone, prednisone, hydrocortisone)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_systemiccs_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_systemiccs_2] = '1'",,RH,,,,
y_systemiccs_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_systemiccs_2] = '1'",,,,,,
y_endocrinemeds_2,one_year_infant_followup_b,,radio,"Any medications for endocrine-related disorders
(Examples: Desmopressin, Diazoxide, Glucagon, Growth hormone, Insulin, Lupron, Octreotide, Testosterone, Thyroxine)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_endocrinemeds_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_endocrinemeds_2] = '1'",,RH,,,,
y_endocrinemeds_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_endocrinemeds_2] = '1'",,,,,,
y_antihyperten_2,one_year_infant_followup_b,,radio,"Any anti-hypertensive medication
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antihyperten_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_antihyperten_2] = '1'",,RH,,,,
y_antihyperten_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antihyperten_2] = '1'",,,,,,
y_antibiotics_2,one_year_infant_followup_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antibiotics_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_antibiotics_2] = '1'",,RH,,,,
y_antibiotics_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antibiotics_2] = '1'",,,,,,
y_probiotics_2,one_year_infant_followup_b,,radio,"Any probiotics (prescribed or over-the-counter)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_probiotics_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_probiotics_2] = '1'",,RH,,,,
y_probiotics_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_probiotics_2] = '1'",,,,,,
y_other1_2,one_year_infant_followup_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other1_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_other1_2] = '1'",,RH,,,,
y_other1_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_other1_2] = '1'",,,,,,
y_other2_2,one_year_infant_followup_b,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other2_s_2,one_year_infant_followup_b,,text,"",,"999 if unknown",,,,,"[y_other2_2] = '1'",,RH,,,,
y_other2_dur_2,one_year_infant_followup_b,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_other2_2] = '1'",,,,,,
y_comments_2,one_year_infant_followup_b," ",notes,"General comments",,,,,,,,,,,,,
y_date_3,one_year_infant_followup_c,,text,"Date (records current to)",,,date_dmy,,,,,,,,,,
y_baby_3,one_year_infant_followup_c,,radio,"If non-singleton delivery, information below is for:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
y_weightgain_3,one_year_infant_followup_c,,radio,"Poor weight gain / failure-to-thrive","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_weightgain_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_weightgain_3] = '1'",,RH,,,,
y_anaphylaxis_3,one_year_infant_followup_c,,radio,Anaphylaxis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_anaphylaxis_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_anaphylaxis_3] = '1'",,RH,,,,
y_rhinitis_3,one_year_infant_followup_c,,radio,"Allergic rhinitis","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_rhinitis_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_rhinitis_3] = '1'",,RH,,,,
y_kawasaki_3,one_year_infant_followup_c,,radio,"Kawasaki disease","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_kawasaki_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_kawasaki_3] = '1'",,RH,,,,
y_asthma_3,one_year_infant_followup_c,,radio,Asthma,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_asthma_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_asthma_3] = '1'",,RH,,,,
y_oxygen_3,one_year_infant_followup_c,,radio,"Need for home oxygen for any duration","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_oxygen_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_oxygen_3] = '1'",,RH,,,,
y_dm_3,one_year_infant_followup_c,,radio,"Diabetes mellitus ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_dm_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_dm_3] = '1'",,RH,,,,
y_hypothy_3,one_year_infant_followup_c,,radio,Hypothyroidism,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hypothy_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_hypothy_3] = '1'",,RH,,,,
y_renalfail_3,one_year_infant_followup_c,,radio,"Renal failure requiring replacement therapy","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_renalfail_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_renalfail_3] = '1'",,RH,,,,
y_htn_3,one_year_infant_followup_c,,radio,Hypertension,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_htn_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_htn_3] = '1'",,RH,,,,
y_glom_3,one_year_infant_followup_c,,radio,Glomerulonephritis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_glom_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_glom_3] = '1'",,RH,,,,
y_uti_3,one_year_infant_followup_c,,radio,"Urinary tract infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_uti_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_uti_3] = '1'",,RH,,,,
y_bacteremia_3,one_year_infant_followup_c,,radio,"Culture proven bacteremia","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bacteremia_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_bacteremia_3] = '1'",,RH,,,,
y_meningitis_3,one_year_infant_followup_c,,radio,Meningitis,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_meningitis_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_meningitis_3] = '1'",,RH,,,,
y_otitis_3,one_year_infant_followup_c,,radio,"Otitis media","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_otitis_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_otitis_3] = '1'",,RH,,,,
y_bronchitis_3,one_year_infant_followup_c,,radio,"Acute bronchitis","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bronchitis_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_bronchitis_3] = '1'",,RH,,,,
y_bronchio_3,one_year_infant_followup_c,,radio,"Acute bronchiolitis ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_bronchio_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_bronchio_3] = '1'",,RH,,,,
y_pneumonia_3,one_year_infant_followup_c,,radio,"Pneumonia, any organism","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_pneumonia_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_pneumonia_3] = '1'",,RH,,,,
y_upperresp_3,one_year_infant_followup_c,,radio,"Upper respiratory infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_upperresp_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_upperresp_3] = '1'",,RH,,,,
y_ecoli_3,one_year_infant_followup_c,,radio,"Any infection caused by Escherichia coli","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_ecoli_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_ecoli_3] = '1'",,RH,,,,
y_hinf_3,one_year_infant_followup_c,,radio,"Any infection caused by Haemophilus influenzae","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hinf_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_hinf_3] = '1'",,RH,,,,
y_kpneu_3,one_year_infant_followup_c,,radio,"Any infection caused by Klebsiella pneumoniae","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_kpneu_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_kpneu_3] = '1'",,RH,,,,
y_strep_3,one_year_infant_followup_c,,radio,"Any infection caused by Streptococcus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_strep_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_strep_3] = '1'",,RH,,,,
y_staph_3,one_year_infant_followup_c,,radio,"Any infection caused by Staphylococcus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_staph_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_staph_3] = '1'",,RH,,,,
y_entero_3,one_year_infant_followup_c,,radio,"Enterovirus infection","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_entero_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_entero_3] = '1'",,RH,,,,
y_gastro_3,one_year_infant_followup_c,,radio,"Gastroenteritis ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_gastro_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_gastro_3] = '1'",,RH,,,,
y_constipation_3,one_year_infant_followup_c,,radio,Constipation,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_constipation_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_constipation_3] = '1'",,RH,,,,
y_hfm_3,one_year_infant_followup_c,,radio,"Hand-Foot-and-Mouth Disease","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hfm_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_hfm_3] = '1'",,RH,,,,
y_hsv_3,one_year_infant_followup_c,,radio,"Herpes simplex","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_hsv_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_hsv_3] = '1'",,RH,,,,
y_syncytical_3,one_year_infant_followup_c,,radio,"Respiratory syncytical virus","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_syncytical_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_syncytical_3] = '1'",,RH,,,,
y_varicella_3,one_year_infant_followup_c,,radio,"Varicella (chickenpox)","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_varicella_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_varicella_3] = '1'",,RH,,,,
y_seizures_3,one_year_infant_followup_c,,radio,"Seizures/ on antiepileptic medications ","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_seizures_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_seizures_3] = '1'",,RH,,,,
y_rehosp_3,one_year_infant_followup_c,,radio,Rehospitalization,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_rehosp_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_rehosp_3] = '1'",,RH,,,,
y_covid_3,one_year_infant_followup_c,,radio,"Acquire or relapse of COVID after 6-8 week follow-up?","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_covid_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_covid_3] = '1'",,RH,,,,
y_death_3,one_year_infant_followup_c,,radio,"Infant death","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_death_desc_3,one_year_infant_followup_c,,descriptive,"Please complete infant death form
",,,,,,,"[y_death_3] = '1'",,,,,,
y_other_3,one_year_infant_followup_c,,radio,Other,"999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other_des_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_other_3] = '1'",,RH,,,,
y_feed_bf_3,one_year_infant_followup_c,"Type of feeding to date",checkbox,"Breast fed","1, Fed by mother | 999, Unknown",,,,,,,,RH,,,,
y_feed_express_3,one_year_infant_followup_c,,checkbox,"Expressed breast milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_3,,
y_feed_formula_3,one_year_infant_followup_c,,checkbox,"Breast milk substitute - formula","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_3,,
y_feed_donor_3,one_year_infant_followup_c,,checkbox,"Donor milk","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_3,,
y_feed_iv_3,one_year_infant_followup_c,,checkbox,"Intravenous and/or TPN","1, Fed by mother | 2, Fed by alternate health care provider or family, who is NOT currently COVID-19 positive and is NOT a contact of a current COVID-19 case | 3, Fed by alternate health care provider or family, who is either currently COVID-19 positive or a contact of a current COVID-19 case | 999, Unknown",,,,,,,,,,s_feed_aa_3,,
y_antihis_3,one_year_infant_followup_c,"Infant medications",radio,"Antihistamine
(Examples: Atarax (hydroxyzine); Reactine (cetirizine); Rupall (rupadtadine); Blexten (bilastine))
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antihis_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_antihis_3] = '1'",,RH,,,,
y_antihis_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antihis_3] = '1'",,,,,,
y_betaag_3,one_year_infant_followup_c,,radio,"Beta-agonists or inhaled bronchodilators
(Examples: Ventolin (salbutamol); Bricanyl (terbutaline))
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_betaag_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_betaag_3] = '1'",,RH,,,,
y_betaag_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_betaag_3] = '1'",,,,,,
y_inhaledcs_3,one_year_infant_followup_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_inhaledcs_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_inhaledcs_3] = '1'",,RH,,,,
y_inhaledcs_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_inhaledcs_3] = '1'",,,,,,
y_intranasalcs_3,one_year_infant_followup_c,,radio,"Intranasal corticosteroids
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_intranasalcs_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_intranasalcs_3] = '1'",,RH,,,,
y_intranasalcs_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_intranasalcs_3] = '1'",,,,,,
y_systemiccs_3,one_year_infant_followup_c,,radio,"Systemic corticosteroids
(Examples: dexamethasone, prednisone, hydrocortisone)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_systemiccs_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_systemiccs_3] = '1'",,RH,,,,
y_systemiccs_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_systemiccs_3] = '1'",,,,,,
y_endocrinemeds_3,one_year_infant_followup_c,,radio,"Any medications for endocrine-related disorders
(Examples: Desmopressin, Diazoxide, Glucagon, Growth hormone, Insulin, Lupron, Octreotide, Testosterone, Thyroxine)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_endocrinemeds_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_endocrinemeds_3] = '1'",,RH,,,,
y_endocrinemeds_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_endocrinemeds_3] = '1'",,,,,,
y_antihyperten_3,one_year_infant_followup_c,,radio,"Any anti-hypertensive medication
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antihyperten_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_antihyperten_3] = '1'",,RH,,,,
y_antihyperten_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antihyperten_3] = '1'",,,,,,
y_antibiotics_3,one_year_infant_followup_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_antibiotics_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_antibiotics_3] = '1'",,RH,,,,
y_antibiotics_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_antibiotics_3] = '1'",,,,,,
y_probiotics_3,one_year_infant_followup_c,,radio,"Any probiotics (prescribed or over-the-counter)
","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_probiotics_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_probiotics_3] = '1'",,RH,,,,
y_probiotics_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_probiotics_3] = '1'",,,,,,
y_other1_3,one_year_infant_followup_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other1_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_other1_3] = '1'",,RH,,,,
y_other1_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_other1_3] = '1'",,,,,,
y_other2_3,one_year_infant_followup_c,,radio,"","999, Unknown | 0, No | 1, Yes",,,,,,,,RH,,,,
y_other2_s_3,one_year_infant_followup_c,,text,"",,"999 if unknown",,,,,"[y_other2_3] = '1'",,RH,,,,
y_other2_dur_3,one_year_infant_followup_c,,radio,"","1, < 1 week | 2, 1-2 weeks | 3, 3-4 weeks | 4, >4 weeks | 999, Unknown",,,,,,"[y_other2_3] = '1'",,,,,,
y_comments_3,one_year_infant_followup_c," ",notes,"General comments",,,,,,,,,,,,,
z_desc,maternal_death,,descriptive,"Please complete this form in the event of a maternal death. ",,,,,,,,,,,,,
z_date,maternal_death,,text,"Date of death",,,date_dmy,,,,,,,,,,
z_cause,maternal_death,,notes,"Probable cause of death as per clinical report",,"999 if unknown",,,,,,,,,,,
z_autopsy,maternal_death,,radio,"Autopsy completed?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
z_autopsy_date,maternal_death,,text,"",,,date_dmy,,,,"[z_autopsy] = '1'",,RH,,,,
z_autopsy_findings,maternal_death,,notes,"",,"999 if unknown",,,,,"[z_autopsy] = '1'",,RH,,,,
z_autopsy_diagnoses,maternal_death,,notes,"",,"999 if unknown",,,,,"[z_autopsy] = '1'",,RH,,,,
z_autopsy_cause,maternal_death,,notes,"Cause of death as per autopsy report
",,"999 if unknown",,,,,"[z_autopsy] = '1'",,RH,,,,
z_comments,maternal_death,,notes,"General comments",,,,,,,,,,,,,
aa_desc,infant_death_a,,descriptive,"Please complete this form in the event of an infant death. ",,,,,,,,,,,,,
aa_baby,infant_death_a,,radio,"If multiples, this form refers to:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
aa_age,infant_death_a,,text,"Postnatal age in calendar days (Age of infant in hours, if < 24 hours, add ""h"" at the end)",,"999 if unknown",,,,,,,,,,,
aa_cause,infant_death_a,,notes,"Probable cause of death as per clinical report",,"999 if unknown",,,,,,,,,,,
aa_autopsy,infant_death_a,,radio,"Autopsy completed?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
aa_autopsy_date,infant_death_a,,text,"",,,date_dmy,,,,"[aa_autopsy] = '1'",,RH,,,,
aa_autopsy_findings,infant_death_a,,notes,"",,"999 if unknown",,,,,"[aa_autopsy] = '1'",,RH,,,,
aa_autopsy_diagnoses,infant_death_a,,notes,"",,"999 if unknown",,,,,"[aa_autopsy] = '1'",,RH,,,,
aa_autopsy_cause,infant_death_a,,notes,"Cause of death as per autopsy report
",,"999 if unknown",,,,,"[aa_autopsy] = '1'",,RH,,,,
aa_comments,infant_death_a,,notes,"General comments",,,,,,,,,,,,,
aa_desc_2,infant_death_b,,descriptive,"Please complete this form in the event of an infant death. ",,,,,,,,,,,,,
aa_baby_2,infant_death_b,,radio,"If multiples, this form refers to:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
aa_age_2,infant_death_b,,text,"Postnatal age in calendar days (Age of infant in hours, if < 24 hours, add ""h"" at the end)",,"999 if unknown",,,,,,,,,,,
aa_cause_2,infant_death_b,,notes,"Probable cause of death as per clinical report",,"999 if unknown",,,,,,,,,,,
aa_autopsy_2,infant_death_b,,radio,"Autopsy completed?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
aa_autopsy_date_2,infant_death_b,,text,"",,,date_dmy,,,,"[aa_autopsy_2] = '1'",,RH,,,,
aa_autopsy_findings_2,infant_death_b,,notes,"",,"999 if unknown",,,,,"[aa_autopsy_2] = '1'",,RH,,,,
aa_autopsy_diagnoses_2,infant_death_b,,notes,"",,"999 if unknown",,,,,"[aa_autopsy_2] = '1'",,RH,,,,
aa_autopsy_cause_2,infant_death_b,,notes,"Cause of death as per autopsy report
",,"999 if unknown",,,,,"[aa_autopsy_2] = '1'",,RH,,,,
aa_comments_2,infant_death_b,,notes,"General comments",,,,,,,,,,,,,
aa_desc_3,infant_death_c,,descriptive,"Please complete this form in the event of an infant death. ",,,,,,,,,,,,,
aa_baby_3,infant_death_c,,radio,"If multiples, this form refers to:","0, N/a | 1, Baby A | 2, Baby B | 3, Baby C",,,,,,,,RH,,,,
aa_age_3,infant_death_c,,text,"Postnatal age in calendar days (Age of infant in hours, if < 24 hours, add ""h"" at the end)",,"999 if unknown",,,,,,,,,,,
aa_cause_3,infant_death_c,,notes,"Probable cause of death as per clinical report",,"999 if unknown",,,,,,,,,,,
aa_autopsy_3,infant_death_c,,radio,"Autopsy completed?","0, No | 1, Yes | 999, Unknown",,,,,,,,RH,,,,
aa_autopsy_date_3,infant_death_c,,text,"",,,date_dmy,,,,"[aa_autopsy_3] = '1'",,RH,,,,
aa_autopsy_findings_3,infant_death_c,,notes,"",,"999 if unknown",,,,,"[aa_autopsy_3] = '1'",,RH,,,,
aa_autopsy_diagnoses_3,infant_death_c,,notes,"",,"999 if unknown",,,,,"[aa_autopsy_3] = '1'",,RH,,,,
aa_autopsy_cause_3,infant_death_c,,notes,"Cause of death as per autopsy report
",,"999 if unknown",,,,,"[aa_autopsy_3] = '1'",,RH,,,,
aa_comments_3,infant_death_c,,notes,"General comments",,,,,,,,,,,,,
ab_desc,general_medications_prescription_or_overthecounter,,descriptive,"NOTES:
- For any medications/supplmnents taken related to COVID, in pregnancy, intrapartum or 6-8 weeks postpartum, complete respective forms above. For all other medications (maternal) complete this table.
- For any medications/supplements given to infant, either related to COVID, in the case of a NICU admission, or generally, please complete in respective sections above.
",,,,,,,,,,,,,
ab_pregmeds,general_medications_prescription_or_overthecounter,,radio,"I. MEDICATIONS / SUPPLEMENTS DURING PREGNANCY","0, No medications / supplements taken at any time during pregnancy, other than for COVID as indicated on above forms | 999, Unknown",,,,,,,,LV,,,,
ab_pregmeds_s1,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds] = ''",,,,,,
ab_pregmeds_ind1,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds] = ''",,,,,,
ab_pregmeds_s2,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s1] <> ''",,,,,,
ab_pregmeds_ind2,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s1] <> ''",,,,,,
ab_pregmeds_s3,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s2] <> ''",,,,,,
ab_pregmeds_ind3,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s2] <> ''",,,,,,
ab_pregmeds_s4,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s3] <> ''",,,,,,
ab_pregmeds_ind4,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s3] <> ''",,,,,,
ab_pregmeds_s5,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s4] <> ''",,,,,,
ab_pregmeds_ind5,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s4] <> ''",,,,,,
ab_pregmeds_s6,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s5] <> ''",,,,,,
ab_pregmeds_ind6,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s5] <> ''",,,,,,
ab_pregmeds_s7,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s6] <> ''",,,,,,
ab_pregmeds_ind7,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s6] <> ''",,,,,,
ab_pregmeds_s8,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s7] <> ''",,,,,,
ab_pregmeds_ind8,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s7] <> ''",,,,,,
ab_pregmeds_s9,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s8] <> ''",,,,,,
ab_pregmeds_ind9,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s8] <> ''",,,,,,
ab_pregmeds_s10,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_pregmeds_s9] <> ''",,,,,,
ab_pregmeds_ind10,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_pregmeds_s9] <> ''",,,,,,
ab_ipmeds,general_medications_prescription_or_overthecounter,,radio,"II. MEDICATIONS / SUPPLEMENTS INTRAPARTUM (DURING LABOUR UNTIL DELIVERY)","0, No medications / supplements taken at any time intrapartum, other than for COVID as indicated on above forms | 999, Unknown",,,,,,,,LV,,,,
ab_ipmeds_s1,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds] = ''",,,,,,
ab_ipmeds_ind1,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds] = ''",,,,,,
ab_ipmeds_s2,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s1] <> ''",,,,,,
ab_ipmeds_ind2,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s1] <> ''",,,,,,
ab_ipmeds_s3,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s2] <> ''",,,,,,
ab_ipmeds_ind3,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s2] <> ''",,,,,,
ab_ipmeds_s4,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s3] <> ''",,,,,,
ab_ipmeds_ind4,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s3] <> ''",,,,,,
ab_ipmeds_s5,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s4] <> ''",,,,,,
ab_ipmeds_ind5,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s4] <> ''",,,,,,
ab_ipmeds_s6,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s5] <> ''",,,,,,
ab_ipmeds_ind6,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s5] <> ''",,,,,,
ab_ipmeds_s7,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s6] <> ''",,,,,,
ab_ipmeds_ind7,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s6] <> ''",,,,,,
ab_ipmeds_s8,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s7] <> ''",,,,,,
ab_ipmeds_ind8,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s7] <> ''",,,,,,
ab_ipmeds_s9,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s8] <> ''",,,,,,
ab_ipmeds_ind9,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s8] <> ''",,,,,,
ab_ipmeds_s10,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ipmeds_s9] <> ''",,,,,,
ab_ipmeds_ind10,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ipmeds_s9] <> ''",,,,,,
ab_ppmeds,general_medications_prescription_or_overthecounter,,radio,"III. MEDICATIONS / SUPPLEMENTS POSTPARTUM UNTIL 6-8 WEEKS FOLLOW-UP","0, No medications / supplements taken at any time postpartum until 6-8 weeks follow-up, other than for COVID as indicated on above forms | 999, Unknown",,,,,,,,LV,,,,
ab_ppmeds_s1,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds] = ''",,,,,,
ab_ppmeds_ind1,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds] = ''",,,,,,
ab_ppmeds_s2,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s1] <> ''",,,,,,
ab_ppmeds_ind2,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s1] <> ''",,,,,,
ab_ppmeds_s3,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s2] <> ''",,,,,,
ab_ppmeds_ind3,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s2] <> ''",,,,,,
ab_ppmeds_s4,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s3] <> ''",,,,,,
ab_ppmeds_ind4,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s3] <> ''",,,,,,
ab_ppmeds_s5,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s4] <> ''",,,,,,
ab_ppmeds_ind5,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s4] <> ''",,,,,,
ab_ppmeds_s6,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s5] <> ''",,,,,,
ab_ppmeds_ind6,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s5] <> ''",,,,,,
ab_ppmeds_s7,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s6] <> ''",,,,,,
ab_ppmeds_ind7,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s6] <> ''",,,,,,
ab_ppmeds_s8,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s7] <> ''",,,,,,
ab_ppmeds_ind8,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s7] <> ''",,,,,,
ab_ppmeds_s9,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s8] <> ''",,,,,,
ab_ppmeds_ind9,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s8] <> ''",,,,,,
ab_ppmeds_s10,general_medications_prescription_or_overthecounter,,text,"Specify medication / supplement",,"999 if unknown",,,,,"[ab_ppmeds_s9] <> ''",,,,,,
ab_ppmeds_ind10,general_medications_prescription_or_overthecounter,,text,"Indication (reason given)
",,"999 if unknown",,,,,"[ab_ppmeds_s9] <> ''",,,,,,
ab_comments,general_medications_prescription_or_overthecounter," ",notes,"General comments",,,,,,,,,,,,,