<?xml version='1.0' encoding='UTF-8'?>
<!DOCTYPE FreeMedForms>
<FreeMedForms>
    <formdescription>
        <!-- Non translatable values -->
        <authors>Eric Maeker, MD</authors>
        <version>test</version>
        <fmfv>0.9.1</fmfv>
        <cdate>2014-05-31</cdate>
        <lmdate>2014-06-01</lmdate>
        <icon>__theme__/identity.png</icon>
        <weblink/>
        <bibliography/>

        <!-- Translatable values -->
        <license>GPLv3</license>
        <description lang="xx">Socio-demographics data</description>
        <description lang="fr">Données socio-démographiques</description>
        <description lang="de">Sozio-demografische Daten</description>
        <category lang="xx">Generic tools</category>
        <category lang="fr">Outils généraux</category>
        <specialties lang="fr">Outils</specialties>
        <specialties lang="xx">Tools</specialties>

        <updateinfo>
          <updateversion from="" to="0.9.1">
            <text lang="fr">Première version</text>
            <text lang="xx">First version</text>
          </updateversion>
        </updateinfo>

    </formdescription>


<!--
    TODO: ajouter:
        Type de revêtement de sol
        Aide sociale par la mutuelle
        Nombre d'enfants, lieu de vie des enfants
        Poele à charbon
-->


    <MedForm name="Subs::Geriatrics::SocioDemographics" uifilename="./ui/xx/sociodemographics.ui">
        <uilink label="formLabel"/>
        <label lang="xx">Socio-demographics data</label>
        <label lang="fr">Données socio-démographiques</label>
        <label lang="de">Sozio-demografische Daten</label>
        <options>DontPrintEmptyValues;UseFormNameAsNameSpace</options>
        <file type="htmlprintmask">./html/xx/sociodemographic_mask.html</file>
        <file type="htmlexportmask">./html/xx/sociodemographic_mask.html</file>

        <Item type="detailswidget" name="PlaceOfLiving" uifilename="./ui/xx/placeofliving.ui">
            <uilink label="" widget="" layout="placeLayout"/>
            <label lang="xx">Place of living</label>
            <label lang="fr">Lieu de vie</label>
            <label lang="de">Identität und Anschrift</label>
            <label lang="es">Identidad y dirección</label>
            <options>SummaryFontBold;expanded</options>

            <Item type="combo" name="PlaceOfLiving::House">
                <uilink label="placeLabel" widget="placeCombo" layout=""/>
                <label lang="xx">Place of living</label>
                <label lang="fr">Lieu de vie</label>
                <label lang="de">Leben Ort</label>
                <value>
                  <uuid id="0">multistorey</uuid>
                  <uuid id="1">multistoreyGround</uuid>
                  <uuid id="2">singlestorey</uuid>
                  <uuid id="3">apartmentwithlift</uuid>
                  <uuid id="4">apartmentwithoutlift</uuid>
                  <uuid id="5">hearthhousing</uuid>
                  <uuid id="6">nursinghome</uuid>
                  <possible id="0" lang="xx">multi-storey house</possible>
                  <possible id="1" lang="xx">multi-storey house with ability to live on the ground floor</possible>
                  <possible id="2" lang="xx">single storey house</possible>
                  <possible id="3" lang="xx">apartment with lift</possible>
                  <possible id="4" lang="xx">apartment without lift</possible>
                  <possible id="5" lang="xx">hearth housing or equivalent</possible>
                  <possible id="6" lang="xx">nursing home</possible>
                  <possible id="0" lang="fr">maison à étage</possible>
                  <possible id="1" lang="fr">maison à étage avec la possibilité de vivre au rez de chaussée</possible>
                  <possible id="2" lang="fr">maison de plain pied</possible>
                  <possible id="3" lang="fr">appartement avec ascenseur</possible>
                  <possible id="4" lang="fr">appartement sans ascenseur</possible>
                  <possible id="5" lang="fr">foyer logement ou équivalent</possible>
                  <possible id="6" lang="fr">EHPAD</possible>
                  <possible id="0" lang="de">stöckiges Haus</possible>
                  <possible id="1" lang="de">mehrstöckige Haus mit der Möglichkeit, im Erdgeschoss wohnen</possible>
                  <possible id="2" lang="de">schossige Haus</possible>
                  <possible id="3" lang="de">wohnung mit Lift</possible>
                  <possible id="4" lang="de">wohnung ohne Aufzug</possible>
                  <possible id="5" lang="de">hearth housing or equivalent</possible>
                  <possible id="6" lang="de">Pflegeheip</possible>
                  <!-- <default>secondcombo</default> -->
                </value>
            </Item>

            <Item type="combo" name="PlaceOfLiving::ExteriorStairs">
                <uilink label="extStairsLabel" widget="extStairsCombo" layout=""/>
                <label lang="xx">Exteriors stairs</label>
                <label lang="fr">Escaliers extérieurs</label>
                <label lang="de">Außentreppen</label>
                <value>
                    <uuid id="0">yes</uuid>
                    <uuid id="1">no</uuid>
                    <possible id="0" lang="xx">presence of exteriors stairs</possible>
                    <possible id="1" lang="xx">no exteriors stairs</possible>
                    <possible id="0" lang="fr">présence d'escaliers extérieurs</possible>
                    <possible id="1" lang="fr">pas d'escaliers extérieurs</possible>
                    <possible id="0" lang="de">Anwesenheit von Außentreppen</possible>
                    <possible id="1" lang="de">Keine Außentreppe</possible>
                    <!-- <default>secondcombo</default> -->
                </value>
            </Item>

            <Item type="combo" name="PlaceOfLiving::BathRoom">
                <uilink label="bathroomLabel" widget="bathroomCombo" layout=""/>
                <label lang="xx">Bathroom</label>
                <label lang="fr">Salle de bain</label>
                <label lang="de">Bad</label>
                <value>
                    <uuid id="0">bath</uuid>
                    <uuid id="1">showerwithouttray</uuid>
                    <uuid id="2">showerwithtray</uuid>
                    <possible id="0" lang="xx">bath</possible>
                    <possible id="1" lang="xx">shower without tray</possible>
                    <possible id="2" lang="xx">shower with tray</possible>
                    <possible id="0" lang="fr">baignoire</possible>
                    <possible id="1" lang="fr">douche sans bac</possible>
                    <possible id="2" lang="fr">douche avec bac</possible>
                    <possible id="0" lang="de">Bad</possible>
                    <possible id="1" lang="de">ohne duschwanne</possible>
                    <possible id="2" lang="de">duschwanne mit</possible>
                    <!-- <default>secondcombo</default> -->
                </value>
            </Item>

            <Item type="helptext" name="PlaceOfLiving::DisabledHelp">
                <uilink label="disabledHelpLabel" widget="" layout=""/>
                <label lang="xx">Specify in the text editor which rooms are not suitable for disabled.</label>
                <label lang="fr">Précisez dans l'éditeur les pièces qui ne sont pas accessible.</label>
                <label lang="de">Geben Sie im Text-Editor, die Zimmer sind nicht für Behinderte geeignet.</label>
                <options>notprintable</options>
            </Item>

            <Item type="longtext" name="PlaceOfLiving::UnadaptedDisabledRooms">
                <uilink label="disabledLabel" widget="disabledEdit" layout=""/>
                <options>DontPrintEmptyValues</options>
                <label lang="xx">Unadapted rooms for disabled</label>
                <label lang="fr">Pièces non-accessible</label>
                <label lang="de">Unangepasste Zimmer für Behinderte</label>
            </Item>

            <Item type="combo" name="PlaceOfLiving::Cooking">
                <uilink label="cookingLabel" widget="cookingCombo" layout=""/>
                <label lang="xx">Cooking</label>
                <label lang="fr">Cuisinière</label>
                <label lang="de">Herd</label>
                <value>
                    <uuid id="0">nocooker</uuid>
                    <uuid id="1">electriccooker</uuid>
                    <uuid id="2">gascooker</uuid>
                    <possible id="0" lang="xx">no cooker</possible>
                    <possible id="1" lang="xx">electric cooker</possible>
                    <possible id="2" lang="xx">Gas cooker</possible>
                    <possible id="0" lang="fr">pas de cuisinière</possible>
                    <possible id="1" lang="fr">cuisinière électrique</possible>
                    <possible id="2" lang="fr">cuisinière au gaz</possible>
                    <possible id="0" lang="de">kein Ofen</possible>
                    <possible id="1" lang="de">elektroherd</possible>
                    <possible id="2" lang="de">gasherd</possible>
                    <!-- <default>secondcombo</default> -->
                </value>
            </Item>

            <Item type="helptext" name="PlaceOfLiving::DomesticAccident::Help">
                <uilink label="domesticRiskHelp" widget="" layout=""/>
                <label lang="xx">Risk of domestic accidents</label>
                <label lang="fr">Risque d'accident domestiques</label>
                <label lang="de">Gefahr von Haushaltsunfällen</label>
                <options>notprintable</options>
            </Item>

            <Item type="check" name="PlaceOfLiving::DomesticAccident::ExtraHeating">
                <uilink label="" widget="extraHeatingCheck" layout=""/>
                <label lang="xx">Use of extra electric heating mobile</label>
                <label lang="fr">Utilisation de chauffages électriques d'appoint mobiles</label>
                <label lang="de">Die Verwendung von zusätzlichen Elektroheizung mobilee</label>
                <options>printonlychecked</options>
            </Item>

            <Item type="check" name="PlaceOfLiving::DomesticAccident::GroundSheet">
                <uilink label="" widget="groundSheetCheck" layout=""/>
                <label lang="xx">Floor mats that can impede ambulation</label>
                <label lang="fr">Tapis de sol qui peuvent entraver la marche</label>
                <label lang="de">Bodenmatten, die Gehfähigkeit beeinträchtigen können</label>
                <options>printonlychecked</options>
            </Item>

        </Item> <!-- PlaceOfLiving detailswidget -->

        <Item type="detailswidget" name="LifeStyle" uifilename="./ui/xx/lifestyle.ui">
            <uilink label="" widget="" layout="lifestyleLayout"/>
            <label lang="xx">Lifestyle</label>
            <label lang="fr">Mode de vie</label>
            <label lang="de">Lebensstil</label>
            <options>SummaryFontBold;expanded</options>

            <Item type="combo" name="LifeStyle::WithWho">
                <uilink label="isLivingLabel" widget="isLivingComboBox" layout=""/>
                <label lang="xx">Is living</label>
                <label lang="fr">Vie</label>
                <label lang="de">Ist leben</label>
                <value>
                    <uuid id="0">alone</uuid>
                    <uuid id="1">withconjoint</uuid>
                    <uuid id="2">withfamily</uuid>
                    <possible id="0" lang="xx">Alone</possible>
                    <possible id="1" lang="xx">With conjoint</possible>
                    <possible id="2" lang="xx">With family</possible>
                    <possible id="0" lang="fr">Seul</possible>
                    <possible id="1" lang="fr">Avec conjoint</possible>
                    <possible id="2" lang="fr">En famille</possible>
                    <!-- <default>secondcombo</default> -->
                </value>
            </Item>

            <Item type="longtext" name="LifeStyle::Pets">
                <uilink label="petsLabel" widget="petsEdit" layout=""/>
                <label lang="xx">Pets</label>
                <label lang="fr">Animaux de compagnie</label>
                <label lang="de">Haustiere</label>
                <options>DontPrintEmptyValues</options>
            </Item>

            <Item type="longtext" name="LifeStyle::PrimaryCaregiver">
                <uilink label="mainHelperLabel" widget="mainHelperEdit" layout=""/>
                <label lang="xx">Primary caregiver</label>
                <label lang="fr">Aidant principal</label>
                <label lang="de">Primären Bezugsperson</label>
                <options>DontPrintEmptyValues</options>
            </Item>

        </Item> <!-- LifeStyle detailswidget -->

        <Item type="detailswidget" name="MedicalEquipment" uifilename="./ui/xx/availableequipment.ui">
            <uilink label="" widget="" layout="equipmentLayout"/>
            <label lang="xx">Available medical equipment</label>
            <label lang="fr">Matériel médical à disposition</label>
            <label lang="de">medizinische Geräte zur Verfügung</label>
            <options>SummaryFontBold;expanded</options>

            <Item type="multilist" name="MedicalEquipment::House">
                <uilink label="availableEquipmentabel" widget="availableEquipmentView" layout=""/>
                <label lang="xx">Available medical equipment</label>
                <label lang="fr">Matériel médical à disposition</label>
                <label lang="de">Erhältlich medizinische Geräte</label>
                <options>resizeToContent;htmlsemicolonseparator</options>
                <value>
                    <uuid id="0" lang="xx">telealarme</uuid>
                    <uuid id="1" lang="xx">bed</uuid>
                    <uuid id="2" lang="xx">geriatricchair</uuid>
                    <uuid id="3" lang="xx">liftchair</uuid>
                    <uuid id="4" lang="xx">wheelchair</uuid>
                    <uuid id="5" lang="xx">patientlifter</uuid>
                    <uuid id="6" lang="xx">closestool</uuid>
                    <uuid id="7" lang="xx">walkingframeantiskidsystem</uuid>
                    <uuid id="8" lang="xx">wheeledwalkingframe</uuid>
                    <uuid id="9" lang="xx">rolator</uuid>
                    <uuid id="10" lang="xx">crutches</uuid>
                    <uuid id="11" lang="xx">walkingstick</uuid>
                    <uuid id="12" lang="xx">mattressmemoryformfoam</uuid>
                    <uuid id="13" lang="xx">toesarch</uuid>
                    <uuid id="14" lang="xx">cushionmemoryformfoam</uuid>
                    <uuid id="15" lang="xx">grabbarsforbathrooms</uuid>
                    <uuid id="16" lang="xx">grabbarsfortoilets</uuid>
                    <uuid id="17" lang="xx">showerchair</uuid>
                    <uuid id="18" lang="xx">relievertoilet</uuid>
                    <uuid id="19" lang="xx">ramponthestairs</uuid>
                    <uuid id="20" lang="xx">electricwheelchairmanlift</uuid>
                    <uuid id="21" lang="xx">firealarm</uuid>
                    <possible id="0">tele-alarm</possible>
                    <possible id="1">Medical bed</possible>
                    <possible id="2">Geriatric chair</possible>
                    <possible id="3">Lift chair</possible>
                    <possible id="4">Wheel chair</possible>
                    <possible id="5">Patient lifter</possible>
                    <possible id="6">Chaise perçée</possible>
                    <possible id="7">Walking frame antiskid system</possible>
                    <possible id="8">Wheeled walking frame</possible>
                    <possible id="9">Rolator</possible>
                    <possible id="10">Crutches</possible>
                    <possible id="11">Walking stick</possible>
                    <possible id="12">Mattress memory form foam</possible>
                    <possible id="13">Toes arch</possible>
                    <possible id="14">Cushion memory form foam</possible>
                    <possible id="15">Grab bars for bathrooms</possible>
                    <possible id="16">Grab bars for toilets</possible>
                    <possible id="17">showerchair</possible>
                    <possible id="18">Reliever toilet</possible>
                    <possible id="19">Ramp on the stairs</possible>
                    <possible id="20">Electric wheelchair manlift</possible>
                    <possible id="21">Fire alarm</possible>
                    <possible id="0" lang="fr">Télé-alarme</possible>
                    <possible id="1" lang="fr">Lit médicalisé</possible>
                    <possible id="2" lang="fr">Fauteuil gériatrique</possible>
                    <possible id="3" lang="fr">Fauteuil releveur</possible>
                    <possible id="4" lang="fr">Fauteuil roulant</possible>
                    <possible id="5" lang="fr">Lève malade</possible>
                    <possible id="6" lang="fr">Chaise perçée</possible>
                    <possible id="7" lang="fr">Déambulateur anti-dérapant</possible>
                    <possible id="8" lang="fr">Déambulateur avec roulettes avant</possible>
                    <possible id="9" lang="fr">Rolator</possible>
                    <possible id="10" lang="fr">Béquilles</possible>
                    <possible id="11" lang="fr">Cannes</possible>
                    <possible id="12" lang="fr">Matelas anti-escarre à mémoire de forme</possible>
                    <possible id="13" lang="fr">Arceau</possible>
                    <possible id="14" lang="fr">Coussin d'assise anti-escarre à mémoire de forme</possible>
                    <possible id="15" lang="fr">Barre d'appui pour salle de bain</possible>
                    <possible id="16" lang="fr">Barre d'appui pour toilettes</possible>
                    <possible id="17" lang="fr">Fauteuil de douche</possible>
                    <possible id="18" lang="fr">Releveur de toilettes</possible>
                    <possible id="19" lang="fr">Rampe dans les escaliers</possible>
                    <possible id="20" lang="fr">Fauteuil électrique monte-personne</possible>
                    <possible id="21" lang="fr">Alarme incendie</possible>
                </value>
            </Item>

        </Item> <!-- MedicalEquipment detailswidget -->

        <Item type="detailswidget" name="HumanHelpers" uifilename="./ui/xx/humanhelp.ui">
            <uilink label="" widget="" layout="humanLayout"/>
            <label lang="xx">Human helpers</label>
            <label lang="fr">Aides humaines</label>
            <label lang="de">Menschen Helfer</label>
            <options>SummaryFontBold;expanded</options>

            <Item type="radio" name="HumanHelpers::APA">
                <uilink label="apaLabel" widget="" layout="apaLayout"/>
                <label lang="xx">Social help</label>
                <label lang="fr">Aide sociale (APA)</label>
                <label lang="de">Sozialversicherung</label>
                <options>compact</options>
                <value>
                    <uuid id="0">yes</uuid>
                    <uuid id="1">no</uuid>
                    <possible id="0" lang="xx">Yes</possible>
                    <possible id="1" lang="xx">No</possible>
                    <print id="0" lang="xx">Benefits social assistance</print>
                    <print id="1" lang="xx">Does not benefit social assistance</print>
                    <possible id="0" lang="fr">Oui</possible>
                    <possible id="1" lang="fr">Non</possible>
                    <print id="0" lang="fr">Bénéficie de l'APA</print>
                    <print id="1" lang="fr">Ne bénéficie pas de l'APA</print>
                    <possible id="0" lang="de">Ja</possible>
                    <possible id="1" lang="de">Nicht</possible>
                </value>
            </Item>

            <Item type="longtext" name="HumanHelpers::APAText">
                <uilink label="" widget="apaEdit" layout=""/>
                <options>DontPrintEmptyValues</options>
            </Item>

            <Item type="radio" name="HumanHelpers::Carer">
                <uilink label="carerLabel" widget="" layout="carerLayout"/>
                <label lang="xx">Carer</label>
                <label lang="fr">Auxilliaire de vie</label>
                <label lang="de">Pfleger</label>
                <options>compact</options>
                <value>
                    <uuid id="0">yes</uuid>
                    <uuid id="1">no</uuid>
                    <possible id="0" lang="xx">Yes</possible>
                    <possible id="1" lang="xx">No</possible>
                    <possible id="0" lang="fr">Oui</possible>
                    <possible id="1" lang="fr">Non</possible>
                    <possible id="0" lang="de">Ja</possible>
                    <possible id="1" lang="de">Nicht</possible>
                </value>
            </Item>

            <Item type="longtext" name="HumanHelpers::CarerText">
                <uilink label="" widget="carerEdit" layout=""/>
                <options>DontPrintEmptyValues</options>
            </Item>

            <Item type="radio" name="HumanHelpers::GardeMalade">
                <uilink label="gardeMaladeLabel" widget="" layout="gardeMaladeLayout"/>
                <label lang="xx">Garde malade de nuit</label>
                <label lang="fr">Garde malade de nuit</label>
                <options>compact</options>
                <value>
                    <uuid id="0">yes</uuid>
                    <uuid id="1">no</uuid>
                    <possible id="0" lang="xx">Yes</possible>
                    <possible id="1" lang="xx">No</possible>
                    <possible id="0" lang="fr">Oui</possible>
                    <possible id="1" lang="fr">Non</possible>
                    <possible id="0" lang="de">Ja</possible>
                    <possible id="1" lang="de">Nicht</possible>
                </value>
            </Item>

            <Item type="combo" name="HumanHelpers::LegalProtection">
                <uilink label="protectionLabel" widget="protectionCombo" layout=""/>
                <label lang="xx">Legal protection</label>
                <label lang="fr">Protection juridique</label>
                <label lang="de">Rechtsschutz</label>
                <options>compact</options>
                <!-- This item is France specific <country>FR</country> -->
                <value>
                    <uuid id="0">noprotection</uuid>
                    <uuid id="1">sauvegarde</uuid>
                    <uuid id="2">curatelle</uuid>
                    <uuid id="3">curatellereforcee</uuid>
                    <uuid id="4">tutelle</uuid>
                    <uuid id="5">protectiondemandee</uuid>
                    <possible id="0" lang="xx">pas de protection</possible>
                    <possible id="1" lang="xx">sauvegarde de justice</possible>
                    <possible id="2" lang="xx">curatelle</possible>
                    <possible id="3" lang="xx">curatelle renforcée</possible>
                    <possible id="4" lang="xx">tutelle</possible>
                    <possible id="5" lang="xx">demande en cours</possible>
                </value>
            </Item>

            <Item type="longtext" name="HumanHelpers::LegalProtectionText">
                <uilink label="" widget="protectionEdit" layout=""/>
                <options>DontPrintEmptyValues</options>
            </Item>


        </Item> <!-- HumanHelpers detailswidget -->

    </MedForm>

</FreeMedForms>
