Functional Specification for Report Form for Influenza A/H5 (Avian)

1 General Properties

Top Form avian_flu
Style Sheet
Date Format dd/MM/yyyy

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1.1 Display Properties

Text Colour
Text Field Background Colour
Form Background Colour
Button Background Colour
Selected Item Background Colour
Error Message Colour

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2 Menu Plugins

3 Form Definitions

3.1 Form "antiviral_drug"

Name Required Type Description Constraints
name No String None
dosage No String None
start_date No String None
end_date No String None

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3.2 Form "avian_flu"

Name Required Type Description Constraints
reporting_details No List None
patient_details No List None
signs_and_symptoms No List None
history_of_admission_to_hospital No List None
travel_history No List None
occupational_exposure No List None
exposure_to_animal_populations No List None
exposure_to_human_cases No List None
laboratory_investigation_results No List None
prophylaxis_against_influenza No List None
antiviral_drug No List None
outcome No List None

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3.3 Form "exposure_to_animal_populations"

Name Required Type Description Constraints
contact_with_animals Yes String
  • [no,unknown,yes]
entered_confined_animal_spaces Yes String
  • [no,unknown,yes]

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3.4 Form "exposure_to_human_cases"

Name Required Type Description Constraints
contact_with_confirmed_case Yes String
  • [no,unknown,yes]
contact_with_unexplained_respiratory_case Yes String
  • [no,unknown,yes]
contact_with_uncertain_ah5_diagnosis Yes String
  • [no,unknown,yes]
person_part_of_cluster Yes String
  • [applicable,not applicable]
cluster_status Yes String
  • [already known,newly identified]
cluster_identifier No String None
cluster_setting Yes String
  • [extended family,hospital,household,military barracks,other,other residential institution,recreational camps]
other_cluster_setting No String None

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3.5 Form "history_of_admission_to_hospital"

Name Required Type Description Constraints
admitted_to_hospital Yes String
  • [no,unknown,yes]
admission_date No String None
transfer_date No String None
termination_date No String None
isolated_or_cohorted Yes String
  • [no,unknown,yes]
isolation_date No String None
mechanically_ventilated Yes String
  • [no,unknown,yes]
admitted_to_intensive_care Yes String
  • [no,unknown,yes]

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3.6 Form "laboratory_investigation_results"

Name Required Type Description Constraints
positive_influenza_A Yes String
  • [no,unknown,yes]

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3.7 Form "occupational_exposure"

Name Required Type Description Constraints
has_animal_related_occupation Yes String
  • [no,unknown,yes]
laboratory_worker Yes String
  • [no,unknown,yes]
health_care_worker Yes String
  • [no,unknown,yes]

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3.8 Form "outcome"

Name Required Type Description Constraints
status Yes String
  • [deceased,lost_to_follow_up,recovered]
status_date No String None
additional_comments No String None

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3.9 Form "patient_details"

Name Required Type Description Constraints
sex Yes String
  • [female,male,unknown]
date_of_birth Yes String None
age_years No Integer None
age_months No Integer None
surname No String None
first_name No String None
full_address No String None
country No String None
telephone No String None
fax No String None
nationality No String None
ethnicity No String None

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3.10 Form "prophylaxis_against_influenza"

Name Required Type Description Constraints
person_vaccinated Yes String
  • [no,unknown,yes]
country_of_vaccination No String None
taking_antiviral_medication Yes String
  • [no,unknown,yes]
antiviral_drug No List None

3.11.1 Field Level Services for "country_of_vaccination"

3.11.2 Ontology Services

Name:Countries

Description:A list of countries

Ontology Source

Class Name:project35.soa.ontology.sources.SingleColumnTextSource

Description:

Parameters

The following parameters are used to initialise the service

Name Value Description
inputFile Countries.txt

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3.11 Form "reporting_details"

Name Required Type Description Constraints
reporter_name No String None
institution No String None
date_of_report No String None
telephone_number No String None

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3.12 Form "signs_and_symptoms"

Name Required Type Description Constraints
date_of_onset Yes String None
body_temp_more_than_38 Yes String
  • [no,unknown,yes]
cough Yes String
  • [no,unknown,yes]
sore_throat Yes String
  • [no,unknown,yes]
shortness_of_breath Yes String
  • [no,unknown,yes]

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3.13 Form "travel_history"

Name Required Type Description Constraints
travel_outside_UK_last_week Yes String
  • [no,unknown,yes]
visited_area No List None
return_date_to_UK No String None
port No String None
symptomatic_during_travel No String None
residing_in_UK_prior_to_onset Yes String
  • [no,unknown,yes]
residing_in_UK_details No String None

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3.14 Form "visited_area"

Name Required Type Description Constraints
country_area No String None
from_date No String None
to_date No String None

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