Functional Specification for Lyme Disease Clinical Report Form

1 General Properties

1.1 Display Properties

2 Menu Plugins

3 Form Definitions

3.1 Form "Cardiovascular_System"
3.2 Form "Clinical_Information"
3.3 Form "Dermatologic_System"
3.4 Form "igg_western_blot"
3.5 Form "igm_serology_test"
3.6 Form "igm_western_blot"
3.7 Form "Laboratory"
3.8 Form "Lyme_Disease_Report_Form"
3.9 Form "Medical_History"
3.10 Form "Musculoskeletal_System"
3.11 Form "Nervous_System"
3.12 Form "Patient_Information"
3.13 Form "pcr"
3.14 Form "Physician_Contact"
3.15 Form "total_ig_serology_test"

1 General Properties

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

1.1 Display Properties

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

2 Menu Plugins

3 Form Definitions

3.1 Form "Cardiovascular_System"

Name	Required	Type	Description	Constraints
atrioventricular_conduction_defects	Yes	String		[no,yes]

3.2 Form "Clinical_Information"

Name	Required	Type	Description	Constraints
Dermatologic_System	Yes	List		None
Nervous_System	Yes	List		None
Cardiovascular_System	Yes	List		None
Musculoskeletal_System	Yes	List		None

3.3 Form "Dermatologic_System"

Name	Required	Type	Description	Constraints
erythema_migrans	Yes	String		[no,yes]
onset_date	Yes	String		None

Class Name:project35.lymeDisease.ErythemaMigransRecordValidationService

Description:If users indicates that erythema migrans is a factor in the assessment of the dermatologic system, then they must not leave the onset_date blank.

3.4 Form "igg_western_blot"

Name	Required	Type	Description	Constraints
test_result	Yes	String		[equivocal,negative,positive]
test_date	Yes	String		None

3.5 Form "igm_serology_test"

Name	Required	Type	Description	Constraints
test_result	Yes	String		[non-reactive,reactive]
test_date	Yes	String		None

3.6 Form "igm_western_blot"

Name	Required	Type	Description	Constraints
test_result	Yes	String		[equivocal,negative,positive]
test_date	Yes	String		None

3.7 Form "Laboratory"

Name	Required	Type	Description	Constraints
laboratory_name	Yes	String		None
igm_serology_test	No	List		None
total_ig_serology_test	No	List		None
igm_western_blot	No	List		None
igg_western_blot	No	List		None
pcr	No	List		None

3.8 Form "Lyme_Disease_Report_Form"

Name	Required	Type	Description	Constraints
Patient_Information	Yes	List		None
Clinical_Information	Yes	List		None
Medical_History	Yes	List		None
Laboratory	Yes	List		None
Physician_Contact	Yes	List		None
report_date	Yes	String		None

3.9 Form "Medical_History"

Name	Required	Type	Description	Constraints
autoimmune_dysfunction	Yes	String		[no,yes]
rocky_mountain_spotted_fever	Yes	String		[no,yes]
mononucleosis	Yes	String		[no,yes]
eczema_or_atopic_dermatitis	Yes	String		[no,yes]
syphilis	Yes	String		[no,yes]
fibromyalgia	Yes	String		[no,yes]
HIV_or_AIDS	Yes	String		[no,yes]
antiphospholipid_AB	Yes	String		[no,yes]

3.10 Form "Musculoskeletal_System"

Name	Required	Type	Description	Constraints
objective_joint_swelling	Yes	String		[no,yes]

3.11 Form "Nervous_System"

Name	Required	Type	Description	Constraints
autoimmune_dysfunction	Yes	String		[no,yes]
cranial_neuritis	Yes	String		[no,yes]
radiculoneuropathy	Yes	String		[no,yes]
encephalomyelitis	Yes	String		[no,yes]

3.12 Form "Patient_Information"

Name	Required	Type	Description	Constraints
first_name	Yes	String		None
middle_name	Yes	String		None
last_name	Yes	String		None
date_of_birth	Yes	String		None
gender	Yes	String		[female,male]
street_address	Yes	String		None
city	Yes	String		None
state	Yes	String		None
zip	Yes	String		None
phone_number	Yes	String		None

3.13 Form "pcr"

Name	Required	Type	Description	Constraints
test_result	Yes	String		[detected,not detected]
test_date	Yes	String		None

3.14 Form "Physician_Contact"

Name	Required	Type	Description	Constraints
physician_name	Yes	String		None
street_address	No	String		None
city	No	String		None
state	No	String		None
zip	No	String		None
phone_number	No	String		None

3.15 Form "total_ig_serology_test"

Name	Required	Type	Description	Constraints
test_result	Yes	String		[non-reactive,reactive]
test_date	Yes	String		None