{
	"name": "HMIS OPD 003 : REFERRAL NOTE",
	"pages": [
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			"label": "Health Facility Referred To",
			"sections": [
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					"label": "Health Facility Referred To",
					"isExpanded": "true",
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		{
			"label": "Reference",
			"sections": [
				{
					"label": "Reference",
					"isExpanded": "true",
					"questions": [
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							"label": "Date of referral ",
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							"id": "164912"
						},
						{
							"label": "Referral number ",
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						},
						{
							"label": "Patient first name",
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						{
							"label": "Patient last name",
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						},
						{
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							"id": "90266"
						},
						{
							"label": "Age",
							"type": "obs",
							"questionOptions": {
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								"max": "",
								"min": "",
								"showDate": ""
							},
							"id": "989"
						},
						{
							"label": "Sex",
							"type": "obs",
							"questionOptions": {
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								"concept": "dce0e46e-30ab-102d-86b0-7a5022ba4115",
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										"conceptMappings": []
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										"label": "MALE",
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							"id": "90252"
						},
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							"label": "Date of first visit",
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							"label": "History and symptoms",
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							"label": "Investigations done",
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						{
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						{
							"label": "Treatment given",
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							"questionOptions": {
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							"id": "99692"
						},
						{
							"label": "Reasons for referral ",
							"type": "obs",
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							"id": "166621"
						},
						{
							"label": "Name of clinician",
							"type": "obs",
							"questionOptions": {
								"rendering": "text",
								"concept": "1473AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
							},
							"id": "1473"
						},
						{
							"label": "Telephone number",
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							"questionOptions": {
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								"concept": "dce17480-30ab-102d-86b0-7a5022ba4115"
							},
							"id": "90278"
						},
						{
							"label": "Signature/initials",
							"type": "obs",
							"questionOptions": {
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							},
							"id": "166069"
						}
					]
				}
			]
		},
		{
			"label": "Discharge note",
			"sections": [
				{
					"label": "Discharge Note",
					"isExpanded": "true",
					"questions": [
						{
							"label": "Date of arrival",
							"type": "obs",
							"questionOptions": {
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								"concept": "2dd7fb3d-74a9-46a7-9f40-04f7117b4426",
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						},
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							"label": "Date of discharge",
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							"id": "162958"
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						{
							"label": "Further investigations done",
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						{
							"label": "Diagnosis",
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							},
							"id": "99321"
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						{
							"label": "Treatment ",
							"type": "obs",
							"questionOptions": {
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							"id": "99692"
						},
						{
							"label": "Treatment or Surveillance",
							"type": "obs",
							"questionOptions": {
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							},
							"id": "166273"
						},
						{
							"label": "Remarks",
							"type": "obs",
							"questionOptions": {
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							},
							"id": "166250"
						},
						{
							"label": "Clinician Name ",
							"type": "obs",
							"questionOptions": {
								"rendering": "text",
								"concept": "1473AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
							},
							"id": "1473"
						},
						{
							"label": "Telephone number ",
							"type": "obs",
							"questionOptions": {
								"rendering": "text",
								"concept": "dce17480-30ab-102d-86b0-7a5022ba4115"
							},
							"id": "90278"
						},
						{
							"label": "Signature/initials",
							"type": "obs",
							"questionOptions": {
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								"concept": "68d1c2d6f-eb86-4a85-b6b4-c2ff4bb879ce",
								"rows": ""
							},
							"id": "12345"
						}
					]
				}
			]
		}
	],
	"processor": "EncounterFormProcessor",
	"uuid": "xxxx",
	"referencedForms": [],
	"encounterType": "e0e4780f5-b5eb-423b-932f-00b5879df5ab"
}