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<!DOCTYPE html>
<html lang="en" class="no-js"><head>
<title>Enketo-Core Developer template</title>
<link href="http://fonts.googleapis.com/css?family=Open+Sans:400,700,600&subset=latin,cyrillic-ext,cyrillic,greek-ext,greek,vietnamese,latin-ext" rel="stylesheet" type="text/css">
<!--<link type="text/css" href="./build/css/plain.css" media="all" rel="stylesheet" />-->
<link type="text/css" href="./build/css/formhub.css" media="all" rel="stylesheet">
<!--<link type="text/css" href="./build/css/grid.css" media="all" rel="stylesheet" />-->
<!--<link type="text/css" href="./build/css/plain-print.css" media="print" rel="stylesheet" />-->
<link type="text/css" href="./build/css/formhub-print.css" media="print" rel="stylesheet">
<!--<link type="text/css" href="./build/css/grid-pring.css" media="print" rel="stylesheet" />-->
<style typet="text/css">
.form-footer .disabled{
display: none;
}
</style>
<script style="">
// The comment below is used in enketo-core-performance-monitor.
//{{globalModelStr}}
var globalModelStr = "<model> <instance> <FWNewHH encounter_type=\"New Household Registration\" id=\"FWNewHH\" version=\"201604121146\"> <formhub> <uuid\/> <\/formhub> <version\/> <changes\/> <existing_location openmrs_entity=\"encounter\" openmrs_entity_id=\"location_id\"\/> <existing_Country\/> <existing_Division\/> <existing_District\/> <existing_Upazilla\/> <existing_Union\/> <existing_Ward\/> <existing_Subunit\/> <existing_Mauzapara\/> <form_name\/> <today openmrs_entity=\"encounter\" openmrs_entity_id=\"encounter_date\"\/> <start openmrs_entity=\"concept\" openmrs_entity_id=\"163137AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <end openmrs_entity=\"concept\" openmrs_entity_id=\"163138AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWNHREGDATE openmrs_entity=\"concept\" openmrs_entity_id=\"160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWGOBHHID openmrs_entity=\"person_attribute\" openmrs_entity_id=\"GoB_HHID\"\/> <FWJIVHHID openmrs_entity=\"person_attribute\" openmrs_entity_id=\"JiVitA_HHID\"\/> <FWCOUNTRY openmrs_entity=\"person_address\" openmrs_entity_id=\"country\" openmrs_entity_parent=\"usual_residence\"\/> <FWDIVISION openmrs_entity=\"person_address\" openmrs_entity_id=\"stateProvince\" openmrs_entity_parent=\"usual_residence\"\/> <FWDISTRICT openmrs_entity=\"person_address\" openmrs_entity_id=\"countyDistrict\" openmrs_entity_parent=\"usual_residence\"\/> <FWUPAZILLA openmrs_entity=\"person_address\" openmrs_entity_id=\"cityVillage\" openmrs_entity_parent=\"usual_residence\"\/> <FWUNION openmrs_entity=\"person_address\" openmrs_entity_id=\"address1\" openmrs_entity_parent=\"usual_residence\"\/> <FWWARD openmrs_entity=\"person_address\" openmrs_entity_id=\"address2\" openmrs_entity_parent=\"usual_residence\"\/> <FWSUBUNIT openmrs_entity=\"person_address\" openmrs_entity_id=\"address3\" openmrs_entity_parent=\"usual_residence\"\/> <FWMAUZA_PARA openmrs_entity=\"person_address\" openmrs_entity_id=\"address4\" openmrs_entity_parent=\"usual_residence\"\/> <FWGOB_HHID openmrs_entity=\"person_address\" openmrs_entity_id=\"address5\" openmrs_entity_parent=\"usual_residence\"\/> <FWNHHHGPS openmrs_entity=\"person_address\" openmrs_entity_id=\"geopoint\" openmrs_entity_parent=\"usual_residence\"\/> <FWHOHFNAME openmrs_entity=\"person\" openmrs_entity_id=\"first_name\"\/> <FWHOHLNAME openmrs_entity=\"person\" openmrs_entity_id=\"last_name\"\/> <FWHOHBIRTHDATE openmrs_entity=\"person\" openmrs_entity_id=\"birthdate\"\/> <FWHOHGENDER openmrs_entity=\"person\" openmrs_entity_id=\"gender\"\/> <FWNHHMBRNUM openmrs_entity=\"concept\" openmrs_entity_id=\"5611AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWNHHMWRA\/> <woman template=\"\" openmrs_entity=\"person\" openmrs_entity_id=\"New Woman Registration\"> <GOBHHID openmrs_entity=\"person_attribute\" openmrs_entity_id=\"GoB_HHID\"\/> <JiVitAHHID openmrs_entity=\"person_attribute\" openmrs_entity_id=\"JiVitA_HHID\"\/> <REGDATE\/> <FWWOMFNAME openmrs_entity=\"person\" openmrs_entity_id=\"first_name\"\/> <FWWOMLNAME openmrs_entity=\"person\" openmrs_entity_id=\"last_name\"\/> <FWBIRTHDATE openmrs_entity=\"person\" openmrs_entity_id=\"birthdate\"\/> <FWGENDER openmrs_entity=\"person\" openmrs_entity_id=\"gender\"\/> <FWWOMAGE openmrs_entity=\"concept\" openmrs_entity_id=\"1532AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <display_age\/> <FWCWOMSTRMEN openmrs_entity=\"concept\" openmrs_entity_id=\"163006AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWCWOMHUSLIV openmrs_entity=\"concept\" openmrs_entity_id=\"162994AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWCWOMHUSALV openmrs_entity=\"concept\" openmrs_entity_id=\"5561AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWCWOMHUSSTR openmrs_entity=\"concept\" openmrs_entity_id=\"162959AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWELIGIBLE\/> <FWELIGIBLE2 openmrs_entity=\"concept\" openmrs_entity_id=\"162699AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <eligible> <FWWOMANYID openmrs_entity=\"concept\" openmrs_entity_id=\"163087AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWWOMNID\/> <FWWOMRETYPENID openmrs_entity=\"person_identifier\" openmrs_entity_id=\"NID\"\/> <FWWOMRETYPENID_CONCEPT openmrs_entity=\"concept\" openmrs_entity_id=\"163084AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWWOMBID\/> <FWWOMRETYPEBID openmrs_entity=\"person_identifier\" openmrs_entity_id=\"Birth Registration ID\"\/> <FWWOMRETYPEBID_CONCEPT openmrs_entity=\"concept\" openmrs_entity_id=\"163083AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWHUSNAME openmrs_entity=\"concept\" openmrs_entity_id=\"161135AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <FWCOUPLENUM openmrs_entity=\"person_attribute\" openmrs_entity_id=\"CoupleNum\"\/> <FWMARRYDATE\/> <FWWOMCOUNTRY openmrs_entity=\"person_address\" openmrs_entity_id=\"country\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMDIVISION openmrs_entity=\"person_address\" openmrs_entity_id=\"stateProvince\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMDISTRICT openmrs_entity=\"person_address\" openmrs_entity_id=\"countyDistrict\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMUPAZILLA openmrs_entity=\"person_address\" openmrs_entity_id=\"cityVillage\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMUNION openmrs_entity=\"person_address\" openmrs_entity_id=\"address1\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMWARD openmrs_entity=\"person_address\" openmrs_entity_id=\"address2\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMSUBUNIT openmrs_entity=\"person_address\" openmrs_entity_id=\"address3\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMMAUZA_PARA openmrs_entity=\"person_address\" openmrs_entity_id=\"address4\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMGOBHHID openmrs_entity=\"person_address\" openmrs_entity_id=\"address5\" openmrs_entity_parent=\"usual_residence\"\/> <FWWOMGPS openmrs_entity=\"person_address\" openmrs_entity_id=\"geopoint\" openmrs_entity_parent=\"usual_residence\"\/> <\/eligible> <add_women\/> <\/woman> <ELCO\/> <current_formStatus\/> <user_type openmrs_entity=\"concept\" openmrs_entity_id=\"163229AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <external_user_ID openmrs_entity=\"concept\" openmrs_entity_id=\"163161AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA\"\/> <meta> <instanceID\/> <\/meta> <\/FWNewHH> <\/instance> <\/model>";
</script>
</head>
<body>
<div class="main">
<article class="paper">
<!--
This section is to be removed in application
-->
<!--
This form header (markup/css) can be changed in the application.
Just make sure to keep a .form-language-selector element into which the form language selector (<select>)
will be appended by Enketo Core.
-->
<header class="form-header clearfix">
<span class="form-language-selector"><span>Choose Language</span></span>
</header>
<form autocomplete="off" novalidate="novalidate" class="or clearfix" dir="ltr" id="FWNewHH">
<!--This form was created by transforming a OpenRosa-flavored (X)Form using an XSLT sheet created by Enketo LLC.--><section class="form-logo"> </section><h3 id="form-title">নতুন খানা নিবন্ধন ফর্ম</h3><select id="form-languages" data-default-lang="bn"><option value="bn">Bengali</option> <option value="en">English</option> </select>
<label class="question non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWNHREGDATE:label">সাক্ষাৎকারের তারিখ</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWNHREGDATE:label">Date of Interview</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/FWNHREGDATE:hint">আজকের তারিখ দিন</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/FWNHREGDATE:hint">Please enter today's date.</span><input type="date" name="/FWNewHH/FWNHREGDATE" required="required" data-constraint=".<= /FWNewHH/today " data-type-xml="date"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/FWNHREGDATE:jr:constraintMsg">আজকের তারিখের পরের কোন তারিখ
হতে পারবে না</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/FWNHREGDATE:jr:constraintMsg">Date cannot be greater than current date.</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label>
<label class="question non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWGOBHHID:label">GoB HHID</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWGOBHHID:label">GoB HHID</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/FWGOBHHID:hint">কালো কালিতে লেখা সরকারী খানা নম্বর (HHID) যেভাবে ঘরের দেয়াল বা দরজায় দেওয়া আছে সেভাবেই ইনপুট দিন।
সরকারী খানা নম্বর (HHID) পাওয়া না গেলে ৯৯৯৯ ইনপুট দিন</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/FWGOBHHID:hint">Please input the Black – painted Government household ID (HHID) as displayed on the door/wall of the HH. If there is no Government HHID, enter 9999.</span><input type="text" name="/FWNewHH/FWGOBHHID" required="required" data-constraint="regex(., '^(?!0{4})[0-9]{4}$')" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/FWGOBHHID:jr:constraintMsg">অনুগ্রহ করে ০০০১ থেকে ৯৯৯৯ এর মধ্যে ৪ ডিজিটের GoB HHID টাইপ করুন</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/FWGOBHHID:jr:constraintMsg">Please enter 4 digits of GoB HHID from 0001 to 9999</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label>
<label class="question non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWJIVHHID:label">JiVitA HHID</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWJIVHHID:label">JiVitA HHID</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/FWJIVHHID:hint">লাল কালিতে দেয়া জীবিতা খানা নম্বর (HHID) যেভাবে দেয়ালে বা দরজায় দেওয়া আছে সেভাবেই ইনপুট দিন ।
জীবিতা খানা নম্বর (HHID) পাওয়া না গেলে ৯৯৯৯ ইনপুট দিন</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/FWJIVHHID:hint">Please input the RED – painted JiVitA / Study household ID (HHID) as displayed on the door/wall of the HH. Enter 9999 if JiVitA HHID is not found.</span><input type="text" name="/FWNewHH/FWJIVHHID" required="required" data-constraint="regex(., '^(?!0{4})[0-9]{4}$')" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/FWJIVHHID:jr:constraintMsg">অনুগ্রহ করে ০০০১ থেকে ৯৯৯৯ এর মধ্যে ৪ ডিজিটের JiVitA HHID টাইপ করুন</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/FWJIVHHID:jr:constraintMsg">Please enter 4 digits of JiVitA HHID from 0001 to 9999</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label>
<label class="question non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWNHHHGPS:label">জি পি এস</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWNHHHGPS:label">Collect GPS Location of HH</span><span lang="" class="or-hint active">GPS coordinates can only be collected when outside.</span><input type="text" name="/FWNewHH/FWNHHHGPS" data-type-xml="geopoint"/><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span></label>
<label class="question non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWHOHFNAME:label">খানা প্রধানের নাম-</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWHOHFNAME:label">Head of Household Name</span><span class="required">*</span><input type="text" name="/FWNewHH/FWHOHFNAME" required="required" data-constraint="regex(., '^[a-z A-Z]+$' )" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/FWHOHFNAME:jr:constraintMsg">অনুগ্রহ করে A-Z অক্ষরগুলো দিয়ে নাম টাইপ করুন</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/FWHOHFNAME:jr:constraintMsg">-</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label>
<fieldset class="question simple-select "><fieldset><legend><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWHOHGENDER:label">খানা প্রধানের লিঙ্গ</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWHOHGENDER:label">Head of Household Gender</span><span class="required">*</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/FWNewHH/FWHOHGENDER" data-name="/FWNewHH/FWHOHGENDER" value="1" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/FWHOHGENDER/1:label">পুরুষ</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/FWHOHGENDER/1:label">Male</span></label><label class=""><input type="radio" name="/FWNewHH/FWHOHGENDER" data-name="/FWNewHH/FWHOHGENDER" value="2" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/FWHOHGENDER/2:label">মহিলা</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/FWHOHGENDER/2:label">Female</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset>
<label class="question non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWNHHMBRNUM:label">এই খানায় বর্তমানে কতজন মানুষ বসবাস করছে?</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWNHHMBRNUM:label">How many people are currently living in this household?</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/FWNHHMBRNUM:hint">খানার সদস্য সংখ্যা লিখতে 01-29 লিখুন । 30 বা তার বেশী হলে 30 লিখুন। খানার সদস্যের সংখ্যা জানা না থাকলে 99 লিখুন ।</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/FWNHHMBRNUM:hint">Enter 01-29 for the number of household members. Enter 30 if 30 or more. Enter 99 if the total number is unknown.</span><input type="text" name="/FWNewHH/FWNHHMBRNUM" required="required" data-constraint="(regex(., '^(?!0{2})[0-9]{2}$') and .<31) or .=99" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/FWNHHMBRNUM:jr:constraintMsg">খানার সদস্য সংখ্যাকে দুই ডিজিট হিসেবে এন্ট্রি করতে হবে। খানার সদস্য সংখ্যা লিখতে 01- 29 লিখুন । খানার সদস্যের সংখ্যা 30 বা তার বেশি হলে 30 লিখুন। খানার সদস্যের সংখ্যা জানা না থাকলে 99 লিখুন ।</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/FWNHHMBRNUM:jr:constraintMsg">Number should be entered as two digits. Enter 01-29 for the number of household members. Enter 30 if there are 30 or more household members. Enter 99 if the total number is unknown.</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label>
<fieldset class="question simple-select "><fieldset><legend><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/FWNHHMWRA:label">এই খানায় কি ১৩ থেকে ৪৯ বছর বয়সের কোন বিবাহিত মহিলা আছেন?</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/FWNHHMWRA:label">Are there any married women between the ages of 13 - 49 live in this household?</span><span class="required">*</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/FWNewHH/FWNHHMWRA" data-name="/FWNewHH/FWNHHMWRA" value="0" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/FWNHHMWRA/0:label">না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/FWNHHMWRA/0:label">No</span></label><label class=""><input type="radio" name="/FWNewHH/FWNHHMWRA" data-name="/FWNewHH/FWNHHMWRA" value="1" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/FWNHHMWRA/1:label">হ্যাঁ</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/FWNHHMWRA/1:label">Yes</span></label><label class=""><input type="radio" name="/FWNewHH/FWNHHMWRA" data-name="/FWNewHH/FWNHHMWRA" value="9" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/FWNHHMWRA/9:label">জানি না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/FWNHHMWRA/9:label">Don't know</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset>
<section class="or-group or-branch pre-init " name="/FWNewHH/woman" data-relevant=" /FWNewHH/FWNHHMWRA ='1'"><h4><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman:label">মহিলার তথ্যঃ</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman:label">New Woman Registration</span></h4><section class="or-repeat " name="/FWNewHH/woman"><label class="question non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/FWWOMFNAME:label">মহিলার নাম-</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/FWWOMFNAME:label">Woman Name</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/FWWOMFNAME:hint">মহিলার নাম টাইপ করুন</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/FWWOMFNAME:hint">Please type woman's name</span><input type="text" name="/FWNewHH/woman/FWWOMFNAME" required="required" data-constraint="regex(., '^[a-z A-Z]+$' )" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/woman/FWWOMFNAME:jr:constraintMsg">অনুগ্রহ করে A-Z অক্ষরগুলো দিয়ে নাম টাইপ করুন</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/woman/FWWOMFNAME:jr:constraintMsg">-</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="question non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/FWBIRTHDATE:label">মহিলার জন্ম তারিখ</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/FWBIRTHDATE:label">Woman's Date of Birth</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/FWBIRTHDATE:hint">“যদি জন্মনিবন্ধন সনদপত্র থাকে তাহলে জন্মতারিখ সেখান থেকেই সংগ্রহ করুন। যদি জন্মতারিখ বলতে না পারে তাহলে মাসের ১৫ তারিখকে জন্মতারিখ হিসেবে বেছে নিন। যদি জন্মমাস বলতে না পারে তাহলে ৬ বা জুনকে মাস হিসেবে বেছে নিন এবং মহিলা যে বছরটিতে তার জন্ম বলবে সেটি এন্ট্রি করুন।”</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/FWBIRTHDATE:hint">If birth certificate is available take date of birth from birth certificate. If date of birth is unknown choose 15 as the date of birth, if month is unknown choose 06 (June) as month of birth and enter the year of birth as mentioned by the woman.</span><input type="date" name="/FWNewHH/woman/FWBIRTHDATE" required="required" data-constraint="(( /FWNewHH/woman/FWBIRTHDATE )+4380) <= today()" data-type-xml="date"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/woman/FWBIRTHDATE:jr:constraintMsg">মহিলার বয়স অবশ্যই ১২ বছরের বেশী হবে</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/woman/FWBIRTHDATE:jr:constraintMsg">Woman must be older than 12 years of age</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="note or-branch pre-init non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/display_age:label">মহিলার বয়স <span class="or-output" data-value=" /FWNewHH/woman/FWWOMAGE ">
</span></span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/display_age:label">The woman's age is <span class="or-output" data-value=" /FWNewHH/woman/FWWOMAGE ">
</span>.</span><input type="text" name="/FWNewHH/woman/display_age" data-relevant=" /FWNewHH/woman/FWBIRTHDATE !=''" data-type-xml="string" readonly="readonly"/></label><fieldset class="question simple-select "><fieldset><legend><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN:label">আপনার মাসিক কি চালু আছে?</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN:label">Are you still menstruating?</span><span class="required">*</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMSTRMEN" data-name="/FWNewHH/woman/FWCWOMSTRMEN" value="0" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN/0:label">না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN/0:label">No</span></label><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMSTRMEN" data-name="/FWNewHH/woman/FWCWOMSTRMEN" value="1" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN/1:label">হ্যাঁ</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN/1:label">Yes</span></label><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMSTRMEN" data-name="/FWNewHH/woman/FWCWOMSTRMEN" value="9" required="required" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN/9:label">জানি না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMSTRMEN/9:label">Don't know</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset><fieldset class="question simple-select or-branch pre-init "><fieldset><legend><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV:label">আপনি কি বর্তমানে আপনার স্বামীর সাথে বসবাস করছেন?</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV:label">Are you currently living with your husband?</span><span class="required">*</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSLIV" data-name="/FWNewHH/woman/FWCWOMHUSLIV" value="0" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMSTRMEN , '1')" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV/0:label">না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV/0:label">No</span></label><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSLIV" data-name="/FWNewHH/woman/FWCWOMHUSLIV" value="1" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMSTRMEN , '1')" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV/1:label">হ্যাঁ</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV/1:label">Yes</span></label><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSLIV" data-name="/FWNewHH/woman/FWCWOMHUSLIV" value="9" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMSTRMEN , '1')" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV/9:label">জানি না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSLIV/9:label">Don't know</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset><fieldset class="question simple-select or-branch pre-init "><fieldset><legend><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSALV:label">আপনার স্বামী কি জীবিত আছেন?</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSALV:label">Is the husband alive?</span><span class="required">*</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSALV" data-name="/FWNewHH/woman/FWCWOMHUSALV" value="0" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMHUSLIV , '0') or selected( /FWNewHH/woman/FWCWOMHUSLIV , '9')" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSALV/0:label">না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSALV/0:label">No</span></label><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSALV" data-name="/FWNewHH/woman/FWCWOMHUSALV" value="1" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMHUSLIV , '0') or selected( /FWNewHH/woman/FWCWOMHUSLIV , '9')" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSALV/1:label">হ্যাঁ</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSALV/1:label">Yes</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset><fieldset class="question simple-select or-branch pre-init "><fieldset><legend><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR:label">আপনার স্বামী কি স্থায়ী জন্মনিয়ন্ত্রন পদ্ধতি গ্রহণ করেছেন?</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR:label">Is the husband sterilized?</span><span class="required">*</span>
</legend><div class="option-wrapper"><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSSTR" data-name="/FWNewHH/woman/FWCWOMHUSSTR" value="0" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMHUSLIV , '1') or (selected( /FWNewHH/woman/FWCWOMHUSLIV , '9') and selected( /FWNewHH/woman/FWCWOMHUSALV , '1'))" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR/0:label">না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR/0:label">No</span></label><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSSTR" data-name="/FWNewHH/woman/FWCWOMHUSSTR" value="1" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMHUSLIV , '1') or (selected( /FWNewHH/woman/FWCWOMHUSLIV , '9') and selected( /FWNewHH/woman/FWCWOMHUSALV , '1'))" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR/1:label">হ্যাঁ</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR/1:label">Yes</span></label><label class=""><input type="radio" name="/FWNewHH/woman/FWCWOMHUSSTR" data-name="/FWNewHH/woman/FWCWOMHUSSTR" value="9" required="required" data-relevant="selected( /FWNewHH/woman/FWCWOMHUSLIV , '1') or (selected( /FWNewHH/woman/FWCWOMHUSLIV , '9') and selected( /FWNewHH/woman/FWCWOMHUSALV , '1'))" data-type-xml="select1"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR/9:label">জানি না</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/FWCWOMHUSSTR/9:label">Don't know</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset><section class="or-group-data or-branch pre-init " name="/FWNewHH/woman/eligible" data-relevant=" /FWNewHH/woman/FWELIGIBLE ='1'"><fieldset class="question simple-select "><fieldset><legend><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID:label">নিচের কোন পরিচয় পত্রটি মহিলার কাছে আছে?</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID:label">Which of the following IDs does the woman have?</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID:hint">প্রযোজ্য সবগুলো উত্তর নির্বাচন করুন</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID:hint">Select all that apply.</span>
</legend><div class="option-wrapper"><label class=""><input type="checkbox" name="/FWNewHH/woman/eligible/FWWOMANYID" value="1" required="required" data-type-xml="select"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID/1:label">জাতীয় পরিচয়পত্র নম্বর</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID/1:label">National ID Number</span></label><label class=""><input type="checkbox" name="/FWNewHH/woman/eligible/FWWOMANYID" value="2" required="required" data-type-xml="select"/><span lang="bn" class="option-label active" data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID/2:label">জন্ম নিবন্ধন সনদপত্র নম্বর</span><span lang="en" class="option-label " data-itext-id="/FWNewHH/woman/eligible/FWWOMANYID/2:label">Birth Registration ID Number</span></label></div></fieldset><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></fieldset><label class="question or-branch pre-init non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWWOMNID:label">মহিলার জাতীয় পরিচয়পত্র নং-</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWWOMNID:label">Woman's National ID Number</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/eligible/FWWOMNID:hint">জাতীয় পরিচয়পত্রে দেওয়া সরকারী নম্বর যেভাবে দেওয়া আছে সেভাবেই প্রবেশ করান</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/eligible/FWWOMNID:hint">Please input the Government ID as displayed on the national ID card</span><input type="text" name="/FWNewHH/woman/eligible/FWWOMNID" required="required" data-constraint="regex(., '^(?!0{13})[0-9]{13}$') or regex(., '^(?!0{17})[0-9]{17}$')" data-relevant="selected( /FWNewHH/woman/eligible/FWWOMANYID ,'1')" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/woman/eligible/FWWOMNID:jr:constraintMsg">জাতীয় পরিচয়পত্র নং ১৩ অথবা ১৭ ডিজিটের হবে</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/woman/eligible/FWWOMNID:jr:constraintMsg">National ID should be 13 or 17 digits</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="question or-branch pre-init non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPENID:label">মহিলার জাতীয় পরিচয়পত্র নম্বরটি পুনরায় লিখুন</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPENID:label">Re-Type Woman's National ID Number</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPENID:hint">জাতীয় পরিচয়পত্রের নম্বরটি পুনরায় প্রবেশ করান</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPENID:hint">Please re-input the National ID number</span><input type="text" name="/FWNewHH/woman/eligible/FWWOMRETYPENID" required="required" data-constraint=".= /FWNewHH/woman/eligible/FWWOMNID " data-relevant="selected( /FWNewHH/woman/eligible/FWWOMANYID ,'1')" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPENID:jr:constraintMsg">এই নম্বরটি ও পূর্বের স্ক্রিনে দেওয়া জন্ম নিবন্ধন নম্বরটি একই হতে হবে</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPENID:jr:constraintMsg">This number and the one in the previous screen should be same</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="question or-branch pre-init non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWWOMBID:label">মহিলার জন্ম নিবন্ধন সনদ নং-</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWWOMBID:label">Woman's Birth Registration ID</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/eligible/FWWOMBID:hint">জন্ম নিবন্ধন সনদপত্রের সরকারী নম্বর যেভাবে দেওয়া আছে সেভাবেই ইনপুট দিন।</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/eligible/FWWOMBID:hint">Please input the Government ID as displayed on the birth certificate</span><input type="text" name="/FWNewHH/woman/eligible/FWWOMBID" required="required" data-constraint="regex(., '^(?!0{17})[0-9]{17}$')" data-relevant="selected( /FWNewHH/woman/eligible/FWWOMANYID ,'2')" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/woman/eligible/FWWOMBID:jr:constraintMsg">জন্ম নিবন্ধন সনদ নং ১৭ ডিজিটের হবে</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/woman/eligible/FWWOMBID:jr:constraintMsg">Birth Registration ID should be 17 digits</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="question or-branch pre-init non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPEBID:label">মহিলার জন্ম নিবন্ধন সনদ নম্বরটি পুনরায় লিখুন</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPEBID:label">Woman's Birth Registration ID</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPEBID:hint">জন্ম নিবন্ধন নম্বরটি পূনরায় প্রবেশ করান</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPEBID:hint">Please re-input the Birth Registration Number</span><input type="text" name="/FWNewHH/woman/eligible/FWWOMRETYPEBID" required="required" data-constraint=".= /FWNewHH/woman/eligible/FWWOMBID " data-relevant="selected( /FWNewHH/woman/eligible/FWWOMANYID ,'2')" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPEBID:jr:constraintMsg">এই নম্বরটি ও পূর্বের স্ক্রিনে দেওয়া জন্ম নিবন্ধন নম্বরটি একই হতে হবে</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/woman/eligible/FWWOMRETYPEBID:jr:constraintMsg">This number and the one in the previous screen should be same</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="question non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWHUSNAME:label">স্বামীর নাম-</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWHUSNAME:label">Husband's Name</span><span class="required">*</span><span lang="bn" class="or-hint active" data-itext-id="/FWNewHH/woman/eligible/FWHUSNAME:hint">স্বামীর নাম টাইপ করুন</span><span lang="en" class="or-hint " data-itext-id="/FWNewHH/woman/eligible/FWHUSNAME:hint">Please type husband's name</span><input type="text" name="/FWNewHH/woman/eligible/FWHUSNAME" required="required" data-constraint="regex(., '^[a-z A-Z]+$' )" data-type-xml="string"/><span lang="bn" class="or-constraint-msg active" data-itext-id="/FWNewHH/woman/eligible/FWHUSNAME:jr:constraintMsg">অনুগ্রহ করে A-Z অক্ষরগুলো দিয়ে নাম টাইপ করুন</span><span lang="en" class="or-constraint-msg " data-itext-id="/FWNewHH/woman/eligible/FWHUSNAME:jr:constraintMsg">-</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="question non-select or-appearance-numbers "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWCOUPLENUM:label">দম্পতি নং</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWCOUPLENUM:label">Couple Number</span><span class="required">*</span><input type="text" name="/FWNewHH/woman/eligible/FWCOUPLENUM" required="required" data-type-xml="string"/><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label><label class="question non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/eligible/FWMARRYDATE:label">বিবাহের তারিখ</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/eligible/FWMARRYDATE:label">Date of Marriage</span><span class="required">*</span><input type="date" name="/FWNewHH/woman/eligible/FWMARRYDATE" required="required" data-type-xml="date"/><span class="or-constraint-msg active" lang="" data-i18n="constraint.invalid">Value not allowed</span><span class="or-required-msg active" lang="" data-i18n="constraint.required">This field is required</span></label>
</section><!--end of group --><label class="note non-select "><span lang="bn" class="question-label active" data-itext-id="/FWNewHH/woman/add_women:label">নির্দেশনাঃ এই খানায় যদি আরও কোন মহিলা থাকে যাকে রেজিস্ট্রেশন করা হয়নি, তাহলে '+' এ ক্লিক করুন এবং একই প্রক্রিয়ায় পরবর্তী মহিলাকে রেজিস্ট্রেশন করুন</span><span lang="en" class="question-label " data-itext-id="/FWNewHH/woman/add_women:label">If there are any additional unregistered women in this household, select the '+' to add them now.</span><input type="text" name="/FWNewHH/woman/add_women" data-type-xml="string" readonly="readonly"/></label>
</section><!--end of repeat fieldset with name /FWNewHH/woman-->
</section><!--end of group -->
<fieldset id="or-preload-items" style="display:none;"><label class="calculation non-select "><input type="hidden" name="/FWNewHH/today" data-preload="date" data-preload-params="today" data-type-xml="date"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/start" data-preload="timestamp" data-preload-params="start" data-type-xml="dateTime"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/end" data-preload="timestamp" data-preload-params="end" data-type-xml="dateTime"/></label></fieldset><fieldset id="or-calculated-items" style="display:none;"><label class="calculation non-select "><input type="hidden" name="/FWNewHH/form_name" data-calculate=""FWNewHH"" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWCOUNTRY" data-calculate=" /FWNewHH/existing_Country " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWDIVISION" data-calculate=" /FWNewHH/existing_Division " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWDISTRICT" data-calculate=" /FWNewHH/existing_District " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWUPAZILLA" data-calculate=" /FWNewHH/existing_Upazilla " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWUNION" data-calculate=" /FWNewHH/existing_Union " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWWARD" data-calculate=" /FWNewHH/existing_Ward " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWSUBUNIT" data-calculate=" /FWNewHH/existing_Subunit " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWMAUZA_PARA" data-calculate=" /FWNewHH/existing_Mauzapara " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWGOB_HHID" data-calculate=" /FWNewHH/FWGOBHHID " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWHOHLNAME" data-calculate=""."" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/FWHOHBIRTHDATE" data-calculate=""1900-01-01"" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/GOBHHID" data-calculate=" /FWNewHH/FWGOBHHID " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/JiVitAHHID" data-calculate=" /FWNewHH/FWJIVHHID " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/REGDATE" data-calculate=" /FWNewHH/FWNHREGDATE " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/FWWOMLNAME" data-calculate=""."" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/FWGENDER" data-calculate=""2"" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/FWWOMAGE" data-calculate="round((( /FWNewHH/today - /FWNewHH/woman/FWBIRTHDATE ) div 365.25),0)" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/FWELIGIBLE" data-calculate="if( /FWNewHH/woman/FWCWOMSTRMEN ='1' and /FWNewHH/woman/FWCWOMHUSLIV ='1' and ( /FWNewHH/woman/FWCWOMHUSSTR ='0' or /FWNewHH/woman/FWCWOMHUSSTR ='9'),1,0)" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/FWELIGIBLE2" data-calculate="if( /FWNewHH/woman/FWELIGIBLE = '1', '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA', '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA')" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMRETYPENID_CONCEPT" data-calculate=" /FWNewHH/woman/eligible/FWWOMRETYPENID " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMRETYPEBID_CONCEPT" data-calculate=" /FWNewHH/woman/eligible/FWWOMRETYPEBID " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMCOUNTRY" data-calculate=" /FWNewHH/existing_Country " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMDIVISION" data-calculate=" /FWNewHH/existing_Division " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMDISTRICT" data-calculate=" /FWNewHH/existing_District " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMUPAZILLA" data-calculate=" /FWNewHH/existing_Upazilla " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMUNION" data-calculate=" /FWNewHH/existing_Union " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMWARD" data-calculate=" /FWNewHH/existing_Ward " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMSUBUNIT" data-calculate=" /FWNewHH/existing_Subunit " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMMAUZA_PARA" data-calculate=" /FWNewHH/existing_Mauzapara " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMGOBHHID" data-calculate=" /FWNewHH/FWGOBHHID " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/woman/eligible/FWWOMGPS" data-calculate=" /FWNewHH/FWNHHHGPS " data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/ELCO" data-calculate="if( /FWNewHH/FWNHHMWRA = '1', sum( /FWNewHH/woman/FWELIGIBLE ), '0')" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/user_type" data-calculate=""FWA"" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/meta/instanceID" data-calculate="concat('uuid:', uuid())" data-type-xml="string"/></label><label class="calculation non-select "><input type="hidden" name="/FWNewHH/formhub/uuid" data-calculate="'c197c1d3c54d420da21a2d27f9600378'" data-type-xml="string"/></label></fieldset>
</form>
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Used some quick-and-dirty inline CSS styles here because the form-footer should be styled in the
mother application. The HTML markup can be changed as well.
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<button id="validate-form" class="btn btn-primary" style="width:200px; margin-left: calc(50% - 100px);">Validate</button>
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