Encounter Form
Demographics
Patient Number
First Name:
Middle Name:
Last Name:
Gender:
...
Male
Female
Village:
Date Of Birth:
Encounter Details
Encounter Location:
*
Provider Name:
*
Provider system-id:
*
Encounter Date:
*
Signs and Symptoms
Joint Stiffness
Yes
No
Joint Swelling
Yes
No
Joint Pain
Yes
No
Lateral Joint Line Tenderness of knee
Yes
No
Fatigue
Yes
No
Fever
Yes
No