/usr/share/d-rats/forms/hics260.xml is in d-rats 0.3.3-3ubuntu1.
This file is owned by root:root, with mode 0o644.
The actual contents of the file can be viewed below.
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<form id='hics260'>
<title>HICS 260 - Patient Evacuation Tracking Form</title>
<field id='date'>
<caption>Date</caption>
<entry type='date'/>
</field>
<field id='unit'>
<caption>Unit</caption>
<entry type='text'/>
</field>
<field id='patient_name'>
<caption>Patient Name</caption>
<entry type='text'/>
</field>
<field id='patient_age'>
<caption>Age</caption>
<entry type='numeric'>0</entry>
</field>
<field id='patient_mrnum'>
<caption>MR#</caption>
<entry type='text'/>
</field>
<field id='diagnosis'>
<caption>Diagnosis</caption>
<entry type='text'/>
</field>
<field id='physician'>
<caption>Admitting Physician</caption>
<entry type='text'/>
</field>
<field id='family_notified'>
<caption>Family Notified</caption>
<entry type='toggle'>False</entry>
</field>
<field id='family_contact'>
<caption>Family Contact Info</caption>
<entry type='multiline'/>
</field>
<field id='labequip'>
<caption>Accompanying Equipment</caption>
<entry type='label'/>
</field>
<field id='equipment'>
<caption></caption>
<entry type='multiselect'><choice set='n'>Hospital Bed</choice><choice set='n'>IV Pumps</choice><choice set='n'>Isolette/Warmer</choice><choice set='n'>Foley Catheter</choice><choice set='n'>Gurney</choice><choice set='n'>Oxygen</choice><choice set='n'>Traction</choice><choice set='n'>Halo-Device</choice><choice set='n'>Wheel Chair</choice><choice set='n'>Ventilator</choice><choice set='n'>Monitor</choice><choice set='n'>Cranial Bolt/Screw</choice><choice set='n'>Ambulatory</choice><choice set='n'>Chest Tube(s)</choice><choice set='n'>A-Line/Swan</choice><choice set='n'>IO Device</choice></entry>
</field>
<field id='isolation'>
<caption>Isolation</caption>
<entry type='toggle'>False</entry>
</field>
<field id='isolation_type'>
<caption>Isolation Type</caption>
<entry type='text'/>
</field>
<field id='isolation_reason'>
<caption>Isolation Reason</caption>
<entry type='text'/>
</field>
<field id='lab_deploc'>
<caption>Departing Location</caption>
<entry type='label'/>
</field>
<field id='depart_room'>
<caption>Departure Room #</caption>
<entry type='text'/>
</field>
<field id='depart_time'>
<caption>Departure Time</caption>
<entry type='time'/>
</field>
<field id='depart_idband'>
<caption>ID Band Confirmed</caption>
<entry type='toggle'>False</entry>
</field>
<field id='depart_idconf'>
<caption>Confirmed By</caption>
<entry type='text'/>
</field>
<field id='depart_record'>
<caption>Medical Record Sent</caption>
<entry type='toggle'>False</entry>
</field>
<field id='depart_address'>
<caption>Addressograph Sent</caption>
<entry type='toggle'>False</entry>
</field>
<field id='depart_belongings'>
<caption>Belongings</caption>
<entry type='choice'><choice set='y'>None</choice><choice>With Patient</choice><choice>Left in Room</choice></entry>
</field>
<field id='depart_valuables'>
<caption>Valuables</caption>
<entry type='choice'><choice set='y'>None</choice><choice>With Patient</choice><choice>Left in Safe</choice></entry>
</field>
<field id='depart_medications'>
<caption>Medications</caption>
<entry type='choice'><choice set='y'>With Patient</choice><choice>Left on Unit</choice><choice>To Pharmacy</choice></entry>
</field>
<field id='bagmasktubing_sent'>
<caption>Bag/Mask w/Tubing Sent</caption>
<entry type='toggle'>False</entry>
</field>
<field id='bulb_sent'>
<caption>Bulb Syringe Sent</caption>
<entry type='toggle'>False</entry>
</field>
<field id='lab_arriveloc'>
<caption>Arriving Location</caption>
<entry type='label'/>
</field>
<field id='arrive_room'>
<caption>Arrival Room #</caption>
<entry type='text'/>
</field>
<field id='arrive_time'>
<caption>Arrival Time</caption>
<entry type='time'/>
</field>
<field id='arrive_idband'>
<caption>ID Band Confirmed</caption>
<entry type='toggle'>False</entry>
</field>
<field id='arrive_idconf'>
<caption>Confirmed By</caption>
<entry type='text'/>
</field>
<field id='arrive_record'>
<caption>Medical Record Sent</caption>
<entry type='toggle'>False</entry>
</field>
<field id='arrive_address'>
<caption>Addressograph</caption>
<entry type='toggle'>False</entry>
</field>
<field id='arrive_belongings'>
<caption>Belongings Received</caption>
<entry type='toggle'>False</entry>
</field>
<field id='arrive_valuables'>
<caption>Valuables Received</caption>
<entry type='toggle'>False</entry>
</field>
<field id='arrive_medications'>
<caption>Medications Received</caption>
<entry type='toggle'>False</entry>
</field>
<field id='bagmasktubing_recv'>
<caption>Bag/Mask w/Tubing Received</caption>
<entry type='toggle'>False</entry>
</field>
<field id='bulb_recv'>
<caption>Bulb Syringe Received</caption>
<entry type='toggle'>False</entry>
</field>
<field id='lab_transfer'>
<caption>Transferring to Another Facility</caption>
<entry type='label'/>
</field>
<field id='time_to_staging'>
<caption>Time to Staging Area</caption>
<entry type='time'/>
</field>
<field id='time_depart_to_recv'>
<caption>Time Departing to Receiving Facility</caption>
<entry type='time'/>
</field>
<field id='destination'>
<caption>Destination</caption>
<entry type='text'/>
</field>
<field id='transport'>
<caption>Transportation</caption>
<entry type='text'/>
</field>
<field id='idband_conf'>
<caption>ID Band Confirmed</caption>
<entry type='toggle'>False</entry>
</field>
<field id='idband_confby'>
<caption>Confirmed by</caption>
<entry type='text'/>
</field>
<field id='fac_depart_time'>
<caption>Departure Time</caption>
<entry type='time'/>
</field>
<field id='depart_facility'>
<caption>Facility Name</caption>
<entry type='text'/>
</field>
</form>
</xml>
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