Functional Specification for Bioterrorism Investigation Form

1 General Properties

Top Form Bioterrorism_Investigation_Form
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 "Bioterrorism_Investigation_Form"

This model was derived from the Bioterrorism Investigation Form that was produced by Utah Department of Health. We have created electronic forms which are intended to demonstrate how Project35 could be used to record investigations of bioterrorism. Our use of the model does not imply that the Utah Department of Health endorses these sample electronic forms.

Name Required Type Description Constraints
first_name Yes String None
last_name Yes String None
onset_date Yes String None
disease Yes String
  • [anthrax,botulism,plague,smallpox,tularemia,viral hemorrhagic fever]
past_year_cases_in_health_district Yes Integer None
past_year_cases_in_state Yes Integer None
past_5year_average_cases_in_health_district Yes Integer None
past_5year_average_cases_in_state Yes Integer None
appropriate_exposure Yes String
  • [no,unknown,yes]
appropriate_age Yes String
  • [no,unknown,yes]
appropriate_sex Yes String
  • [no,unknown,yes]
presents_typical_symptoms Yes String
  • [no,unknown,yes]
patient_previously_healthy Yes String
  • [no,unknown,yes]
typical_antibiotic_resistance_profile Yes String
  • [no,unknown,yes]
patient_responding_to_therapy Yes String
  • [no,unknown,yes]
appropriate_time_of_year Yes String
  • [no,unknown,yes]
concurrent_outbreak_in_animals Yes String
  • [no,unknown,yes]
patient_works_in No String
  • [Animals,Government,Healthcare with direct patient contact,Media (Broadcast or print),Research Laboratory]
active_surveillance_initiated Yes String
  • [no,unknown,yes]
comments No String None
Reported_By Yes List None

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3.2 Form "Reported_By"

Name Required Type Description Constraints
name_or_facility No String None
phone_number No String None
date No String None

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