Hypertension Screening

• Demographic Details
  {label: "Name", srce logic: "@patient.name with age gndr if @patient.present?"} :  

  {label: "UHID", srce logic: "@patient.ptnt rgstrtn id if @patient.present?"} :  

  {label: "Phone", srce logic: "@patient.present? ? @patient.nmbr : ''"} :  

  {label: "Address", srce logic: "@patient.present? ? @patient.pm address : ''"} :  

  Are you currently pregnant?

  Please Enter Are you currently pregnant?

  Yes No

  Age

  Please Select Date of Birth

  Age must be greater than 0 and less than 125 Years

  Months must be less than 12

  Days must be less than 31

  -

  -

  Days

  Mnth

  Yrs

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