#patient info
Age: ${Age:}
Sex: ${Sex:}
Gender: ${Gender:}
Diagnosis manual: ${Diagnosis manual used}
#@IF (Diagnosis manual = ICD-10)@ Diagnosis manual: ICD-10 | ICD-11 | DSM-5
@IF (Diagnosis manual = ICD-10)@ Diagnosis: ${Diagnosis (ICD-10)}
#@EVAL{EQUALS("Diagnosis manual", "ICD-10") && EQUALS("Diagnosis", "N/A"}@ Diagnosis: F33.1 | F33.2 | F33.3 | F20.0 | F20.1 | F20.2 | F20.3 | F31.1 | F31.2 | F31.3 | F31.4 | F31.5 | F31.6 | F32.1 | F32.2 | F32.3 | Other (please specify here) 
@IF (Diagnosis manual = ICD-11)@ Diagnosis: ${Diagnosis (ICD-11)}
#@EVAL{EQUALS("Diagnosis manual", "ICD-11") && EQUALS("Diagnosis", "N/A"}@ Diagnosis: 6A70.0 | 6A70.1 | 6A70.2 | 6A70.3 | 6A70.4 | 6A71.0 | 6A71.1 | 6A71.2 | 6A71.3 | 6A71.4 | 6A20.0 | 6A20.1 | 6A20.2 | 6A60.0 | 6A60.1 | 6A60.2 | 6A60.3 | 6A60.4 | 6A60.5 | 6A60.6 | 6A60.7 | 6A60.9 | Other (please specify here)
@IF (Diagnosis manual = DSM-5)@ Diagnosis: ${Diagnosis (DSM-5)}
#@EVAL{EQUALS("Diagnosis manual", "DSM-5") && EQUALS("Diagnosis", "N/A"}@ Diagnosis: 296.32 | 296.33 | 296.34 | 295.90 | 295.70 | 296.42 | 296.43 | 296.44 | 296.52 | 296.53 | 296.64| 293.89 | 293.89 | 293.89 | Other (please specify here)
Year of first ECT: ${Year of first ECT:}
@IF (PATIENT TREATMENT NO = 1)@ Weight: ${Weight:}
@EVAL{NUMVAL("PATIENT TREATMENT NO") % 6 != 0}@ Weight: ${PREVIOUS.Weight:}
@EVAL{!HAS("Restimulation_applied") && NUMVAL("PATIENT TREATMENT NO") % 6 == 0}@ Weight: @PROMPT@
@EVAL{HAS("Restimulation_applied") && NUMVAL("PATIENT TREATMENT NO") % 6 == 0}@ Weight: ${PREVIOUS.Weight:}


# In case of restimulation all fields are preset with peviously entered data
@IF(Restimulation_applied)@ Patient Status: ${PREVIOUS.Patient Status:}
@IF(Restimulation_applied)@ ECT Course: ${PREVIOUS.ECT Course:}
@IF(Restimulation_applied)@ CURRENT ECT SERIES NUMBER: ${PREVIOUS.CURRENT ECT SERIES NUMBER:}
@IF(Restimulation_applied)@ Restimulation: Yes
@IF(Restimulation = Yes)@ Electrode Position: ${PREVIOUS.Electrode Position:}
@IF(Restimulation = Yes)@ Anesthetic: ${PREVIOUS.Anesthetic:}
@IF(Restimulation = Yes)@ Anesthetic dose (mg): ${PREVIOUS.Anesthetic dose (mg):}
@IF(Restimulation = Yes)@ Anesthetic add: ${PREVIOUS.Anesthetic add:}
@IF(Restimulation = Yes)@ Anesthetic add dose (mg):${PREVIOUS.Anesthetic add dose (mg):}
@IF(Restimulation = Yes)@ Relaxant: ${PREVIOUS.Relaxant:}
@IF(Restimulation = Yes)@ Relaxant dose (mg): ${PREVIOUS.Relaxant dose (mg):}
@IF(Restimulation = Yes)@ Relaxant add: ${PREVIOUS.Relaxant add:}
@IF(Restimulation = Yes)@ Relaxant add dose (mg): ${PREVIOUS.Relaxant add dose (mg):}
@IF(Restimulation = Yes)@ Analgesics: ${PREVIOUS.Analgesics:}
@IF(Restimulation = Yes)@ Analgesics dose (mg):${PREVIOUS.Analgesics dose (mg):}
@IF(Restimulation = Yes)@ Analgesics add: ${PREVIOUS.Analgesics add:}
@IF(Restimulation = Yes)@ Analgesics add dose (mg):${PREVIOUS.Analgesics add dose (mg):}
@IF(Restimulation = Yes)@ Antiemetics: ${PREVIOUS.Antiemetics:}
@IF(Restimulation = Yes)@ Antiemetics dose (mg): ${PREVIOUS.Antiemetics dose (mg):}
@IF(Restimulation = Yes)@ Antiemetics add: ${PREVIOUS.Antiemetics add:}
@IF(Restimulation = Yes)@ Antiemetics add dose (mg): ${PREVIOUS.Antiemetics add dose (mg):}
@IF(Restimulation = Yes)@ Antihypertensives: ${PREVIOUS.Antihypertensives:}
@IF(Restimulation = Yes)@ Antihypertensive dose (mg): ${PREVIOUS.Antihypertensive dose (mg):}
@IF(Restimulation = Yes)@ Anticholinergic: ${PREVIOUS.Anticholinergic:}
@IF(Restimulation = Yes)@ Anticholinergic dose (mg): ${PREVIOUS.Anticholinergic dose (mg):}
@IF(Restimulation = Yes)@ Concurrent medication_1: ${PREVIOUS.Concurrent medication_1:}
@IF(Restimulation = Yes)@ Concurrent medication_1 dose (mg): ${PREVIOUS.Concurrent medication_1 dose (mg):}
@IF(Restimulation = Yes)@ Concurrent medication_2: ${PREVIOUS.Concurrent medication_2:}
@IF(Restimulation = Yes)@ Concurrent medication_2 dose (mg): ${PREVIOUS.Concurrent medication_2 dose (mg):}
@IF(Restimulation = Yes)@ Concurrent medication_3: ${PREVIOUS.Concurrent medication_3:}
@IF(Restimulation = Yes)@ Concurrent medication_3 dose (mg): ${PREVIOUS.Concurrent medication_3 dose (mg):}
@IF(Restimulation = Yes)@ Concurrent medication_4: ${PREVIOUS.Concurrent medication_4:}
@IF(Restimulation = Yes)@ Concurrent medication_4 dose (mg): ${PREVIOUS.Concurrent medication_4 dose (mg):}
@IF(Restimulation = Yes)@ Concurrent medication_5: ${PREVIOUS.Concurrent medication_5:}
@IF(Restimulation = Yes)@ Concurrent medication_5 dose (mg): ${PREVIOUS.Concurrent medication_5 dose (mg):}
@IF(Restimulation = Yes)@ ECT Practitioner: ${PREVIOUS.ECT Practitioner:}
@IF(Restimulation = Yes)@ CGI (1-normal, 7-Among the most extremly ill patients): ${PREVIOUS.CGI (1-normal, 7-Among the most extremly ill patients):}

# Here we are pre-treatment 

# ECT Course
@UNLESS(%Restimulation_applied)@ Patient Status: Inpatient | Outpatient
@UNLESS(%Restimulation_applied)@ ECT Course: Acute | Maintenance
@EVAL{!HAS("Restimulation_applied")}@ CURRENT ECT SERIES NUMBER: ${PATIENT ECT SERIES NUMBER}
@UNLESS(%Restimulation_applied)@ Restimulation: No


# Electrode Position
@IF (Restimulation = No)@ Electrode Position: Bifrontal | Bitemporal | LART | RUL | LUL | Other (please specify)

# Anesthetics:
@IF(Restimulation = No)@ Anesthetic: Propofol | Etomidate | Remifentanil (TCI)| Thiopental | Methohexital | Ketamine | Ketofol | (please specify other here)
@IF(Restimulation = No)@ Anesthetic dose (mg):
@IF(Restimulation = No)@ Anesthetic add: None | Remifentanil (TCI)| Propofol | Etomidate | Thiopental | Methohexital | Ketamine | Ketofol | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS ("Anesthetic add", "None")}@ Anesthetic add dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && !EQUALS ("Anesthetic add", "None")}@ Anesthetic add dose (mg):

#Relaxant:
@IF(Restimulation = No)@ Relaxant: Succinylcholine | Rocuronium | (please specify other here)
@IF(Restimulation = No)@ Relaxant dose (mg):
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Relaxant", "Succinylcholine")}@ Relaxant add: None
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Relaxant", "Succinylcholine")}@ Relaxant add dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Relaxant", "Rocuronium")}@ Relaxant add: Sugammadex | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Relaxant", "Rocuronium")}@ Relaxant add dose (mg):

#Analgesics:
@IF(Restimulation = No)@ Analgesics: None | Paracetamol | Metamizole | Ketorolac | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS ("Analgesics", "None")}@ Analgesics dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && !EQUALS ("Analgesics", "None")}@ Analgesics dose (mg):

@EVAL{EQUALS("Restimulation", "No") && EQUALS("Analgesics", "None")}@ Analgesics add: None 
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Analgesics", "None")}@ Analgesics add dose (mg): N/A

@EVAL{EQUALS("Restimulation", "No") && !EQUALS("Analgesics", "None")}@ Analgesics add: None | Paracetamol | Metamizole | Ketorolac | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && !EQUALS("Analgesics", "None") && EQUALS ("Analgesics add", "None")}@ Analgesics add dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && !EQUALS("Analgesics", "None") && !EQUALS ("Analgesics add", "None")}@ Analgesics add dose (mg):

#Antiemetics:
@IF(Restimulation = No)@ Antiemetics: None | Dimenhydrinat (Vomex)| Metoclopramid | Dexamethason | Ondansetron | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS ("Antiemetics", "None")}@ Antiemetics dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && !EQUALS ("Antiemetics", "None")}@ Antiemetics dose (mg):

@EVAL{EQUALS("Restimulation", "No") && EQUALS("Antiemetics", "None")}@ Antiemetics add: None 
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Antiemetics", "None")}@ Antiemetics add dose (mg): N/A

@EVAL{EQUALS("Restimulation", "No") && !EQUALS("Antiemetics", "None")}@ Antiemetics add: None | Dimenhydrinat (Vomex) | Metoclopramid | Dexamethason | Ondansetron | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && !EQUALS("Antiemetics", "None") && EQUALS ("Antiemetics add", "None")}@ Antiemetics add dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && !EQUALS("Antiemetics", "None") && !EQUALS ("Antiemetics add", "None")}@ Antiemetics add dose (mg):

#Antihypertensives:
@IF(Restimulation = No)@ Antihypertensives: None | Clonidine | Urapidil | Metoprolol | Nitroglycerin | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS ("Antihypertensives", "None")}@ Antihypertensive dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && !EQUALS ("Antihypertensives", "None")}@ Antihypertensive dose (mg):

#Anticholinergic:
@IF(Restimulation = No)@ Anticholinergic: None | Glycopyrronium | Atropin | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS ("Anticholinergic", "None")}@ Anticholinergic dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && !EQUALS ("Anticholinergic", "None")}@ Anticholinergic dose (mg):

##Additional Medication
@IF(Restimulation = No)@ Additional medication: No | Yes
# No additional medication
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_1: None 
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_1 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_2: None
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_2 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_3: None
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_3 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_4: None
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_4 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_5: None
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "No")}@ Concurrent medication_5 dose (mg): N/A
# Additional medication
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes")}@ Concurrent medication_1: None | Caffeine | Propofol postictal | Flumazenil | Metamizole | Ketorolac | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && EQUALS("Concurrent medication_1", "None")}@ Concurrent medication_1 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && !EQUALS("Concurrent medication_1", "None")}@ Concurrent medication_1 dose (mg): 

@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes")}@ Concurrent medication_2: None | Caffeine | Propofol postictal | Flumazenil | Metamizole | Ketorolac | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && EQUALS("Concurrent medication_2", "None")}@ Concurrent medication_2 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && !EQUALS("Concurrent medication_2", "None")}@ Concurrent medication_2 dose (mg):

@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes")}@ Concurrent medication_3: None | Caffeine | Propofol postictal | Flumazenil | Metamizole | Ketorolac | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && EQUALS("Concurrent medication_3", "None")}@ Concurrent medication_3 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && !EQUALS("Concurrent medication_3", "None")}@ Concurrent medication_3 dose (mg):

@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes")}@ Concurrent medication_4: None | Caffeine | Propofol postictal | Flumazenil | Metamizole | Ketorolac | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && EQUALS("Concurrent medication_4", "None")}@ Concurrent medication_4 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && !EQUALS("Concurrent medication_4", "None")}@ Concurrent medication_4 dose (mg):

@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes")}@ Concurrent medication_5: None | Caffeine | Propofol postictal | Flumazenil | Metamizole | Ketorolac | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && EQUALS("Concurrent medication_5", "None")}@ Concurrent medication_5 dose (mg): N/A
@EVAL{EQUALS("Restimulation", "No") && EQUALS("Additional medication", "Yes") && !EQUALS("Concurrent medication_5", "None")}@ Concurrent medication_5 dose (mg):

# ECT Practitioner
@IF(Restimulation = No)@ ECT Practitioner:

#CGI
@IF(Restimulation = No)@ CGI (1-normal, 7-Among the most extremly ill patients): 1|2|3|4|5|6|7

#Here we are post-treatment
@IF(% Energy Set)@ PostTreatment: Yes
@IF(% Energy Set)@ EEG seizure length:
@IF(EMG Endpoint)@ Motor seizure length:

@EVAL{EQUALS("PostTreatment", "Yes") && EQUALS("Anesthetic", "Remifentanil (TCI)")}@ Remifentanil total (mg):

@EVAL{EQUALS("PostTreatment", "Yes") && EQUALS("Anesthetic add","Remifentanil (TCI)")}@ Remifentanil total (mg):

#Changes to medication
@IF(% Energy Set)@ Changes made to medication: No | Yes

#No changes to medication
@IF(Changes made to medication = No)@ medication_changes 1: None 
@IF(Changes made to medication = No)@ medication_changes 1 dose (mg): N/A
@IF(Changes made to medication = No)@ medication_changes 2: None 
@IF(Changes made to medication = No)@ medication_changes 2 dose (mg): N/A
@IF(Changes made to medication = No)@ medication_changes 3: None 
@IF(Changes made to medication = No)@ medication_changes 3 dose (mg): N/A

#Changes made to medication
@IF(Changes made to medication = Yes)@ medication_changes 1: None | Propofol | Propofol postictal | Midazolam | Clonazepam | Dexmedetomidine | Urapidil | Metoprolol | Nitroglycerin | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Changes made to medication", "Yes") && EQUALS("medication_changes 1","None")}@ medication_changes 1 dose (mg): N/A
@EVAL{EQUALS("Changes made to medication", "Yes") && !EQUALS("medication_changes 1","None")}@ medication_changes 1 dose (mg):

@IF(Changes made to medication = Yes)@ medication_changes 2: None | Propofol | Propofol postictal | Midazolam | Clonazepam | Dexmedetomidine | Urapidil | Metoprolol | Nitroglycerin | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Changes made to medication", "Yes") && EQUALS("medication_changes 2","None")}@ medication_changes 2 dose (mg): N/A
@EVAL{EQUALS("Changes made to medication", "Yes") && !EQUALS("medication_changes 2","None")}@ medication_changes 2 dose (mg):

@IF(Changes made to medication = Yes)@ medication_changes 3: None | Propofol | Propofol postictal | Midazolam | Clonazepam | Dexmedetomidine | Urapidil | Metoprolol | Nitroglycerin | Lorazepam postictal | (please specify other here)
@EVAL{EQUALS("Changes made to medication", "Yes") && EQUALS("medication_changes 3","None")}@ medication_changes 3 dose (mg): N/A
@EVAL{EQUALS("Changes made to medication", "Yes") && !EQUALS("medication_changes 3","None")}@ medication_changes 3 dose (mg):

#Seizuer evaluation
@IF(% Energy Set)@ Seizure evaluation (1-insufficient, 2-sufficient, 3-ideal): 
@IF(% Energy Set)@ Recommendation:

#Comments
@IF(% Energy Set)@ Further comments: No | Yes
@IF(Further comments = No)@ Comment: None
@IF(Further comments = Yes)@ Comment: @MULTILINE@

# Thymatron additinal information
@IF(Thymatron System IV S/N)@ Patient Treatment Number: ${PATIENT TREATMENT NO}
@IF(Thymatron System IV S/N)@ Treatment Counter: ${TREATMENT COUNTER}
@IF(Thymatron System IV S/N)@ Date of Treatment: ${TREATMENT DATE}
#@IF(Thymatron System IV S/N)@ Exact Treatment Date: ${TIMESTAMP}
@IF(Thymatron System IV S/N)@ Date: ${YEAR}-${MONTH}-${DAY}
@IF(Thymatron System IV S/N)@ Thymatron Serial Number: ${Thymatron System IV S/N}
@IF(Thymatron System IV S/N)@ Program Selected: ${Program Selected}
@IF(Thymatron System IV S/N)@ Genet ID: ${Thymatron System IV S/N}_${Patient ID:}
