diff --git a/src/forms/ict-general/1.0.json b/src/forms/ict-general/1.0.json new file mode 100644 index 00000000..2d6b74a8 --- /dev/null +++ b/src/forms/ict-general/1.0.json @@ -0,0 +1,1036 @@ +{ + "name": "POC ICT General", + "version": "1.0", + "published": true, + "retired": false, + "encounter": "ICT General", + "processor": "EncounterFormProcessor", + "referencedForms": [], + "uuid": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", + "encounterType": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", + "allowUnspecifiedAll": true, + "pages": [ + { + "label": "POC ICT General", + "sections": [ + { + "label": "ICT General", + "isExpanded": "true", + "questions": [ + { + "label": "Linked to App. service", + "type": "obs", + "required": false, + "id": "linkedToApp", + "questionOptions": { + "rendering": "radio", + "concept": "bb6e58c7-2691-4f22-9b6f-4d45e3606184", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "ICT Serial Number", + "type": "obs", + "required": true, + "id": "ictNumber", + "questionOptions": { + "rendering": "text", + "concept": "b35f9632-9ff8-410f-bfcb-f497023bbcf9", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "Index first name", + "type": "obs", + "required": false, + "id": "indexFirstName", + "questionOptions": { + "rendering": "text", + "concept": "166102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "2725" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166102" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "408677003" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Index middle name", + "type": "obs", + "required": false, + "id": "indexMiddleName", + "questionOptions": { + "rendering": "text", + "concept": "166574AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "716057004" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166574" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Index last name", + "type": "obs", + "required": false, + "id": "indexLastName", + "questionOptions": { + "rendering": "text", + "concept": "166103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "2724" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "397678008" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166103" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Marital status", + "type": "obs", + "required": false, + "id": "maritalStatus", + "questionOptions": { + "rendering": "radio", + "concept": "1054AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "AMPATH", + "value": "1054" + }, + { + "relationship": "SAME-AS", + "type": "PIH-Malawi", + "value": "1054" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "1054" + }, + { + "relationship": "SAME-AS", + "type": "PIH-Malawi", + "value": "1054" + }, + { + "relationship": "SAME-AS", + "type": "AMPATH", + "value": "1054" + }, + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "3350" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "365581002" + }, + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "3350" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "365581002" + } + ], + "answers": [ + { + "concept": "1058AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Divorced" + }, + { + "concept": "135704AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Lives alone" + }, + { + "concept": "1060AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Living with partner" + }, + { + "concept": "5555AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Married" + }, + { + "concept": "1057AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Never married" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other non-coded" + }, + { + "concept": "1056AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Separated" + }, + { + "concept": "1059AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Widowed" + } + ] + }, + "validators": [] + }, + { + "label": "Do you know about HIVST?", + "type": "obs", + "required": false, + "id": "hivst", + "questionOptions": { + "rendering": "radio", + "concept": "6949f032-06d5-4019-abce-dba4bb46e192", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "If yes, have you ever recommended your friends for HIVST?", + "type": "obs", + "required": false, + "id": "recommendedHivst", + "questionOptions": { + "rendering": "radio", + "concept": "0bc4754a-473f-4929-826e-8b11bee4ea0e", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Have you ever tested using HIVST?", + "type": "obs", + "required": false, + "id": "testedUsingHivst", + "questionOptions": { + "rendering": "radio", + "concept": "166464AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166464" + }, + { + "relationship": "SAME-AS", + "type": "KenyaEMR", + "value": "164952" + } + ], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + }, + { + "concept": "1067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Unknown" + } + ] + } + }, + { + "label": "Case finding strategy", + "type": "obs", + "required": false, + "id": "caseFindingStrategy", + "questionOptions": { + "rendering": "radio", + "concept": "f81ddad3-ba72-4670-91d4-1dbed708958b", + "conceptMappings": [], + "answers": [ + { + "concept": "9d0e9067-33a0-4d14-ad18-0baa4eab4297", + "label": "PICT (Provider-initiated counseling and testing)" + }, + { + "concept": "160539AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Voluntary counseling and testing program" + }, + { + "concept": "160526AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Early Infant Diagnosis Visit" + } + ] + } + }, + { + "label": "If PICT,", + "type": "obs", + "required": false, + "id": "ifPict", + "questionOptions": { + "rendering": "radio", + "concept": "e5d1cf7c-d14a-49d2-bbdc-621804269115", + "conceptMappings": [], + "answers": [ + { + "concept": "6b4d8d21-a278-4649-963f-985025b28806", + "label": "ANC (Absolute neutrophil count)" + }, + { + "concept": "afcd8ca6-4706-4a0f-8d3b-bb46781a1698", + "label": "HRST (HIV risk screening tool)" + }, + { + "concept": "ca7df214-3fef-48d6-b8d7-16da8e921c4c", + "label": "ICT (Index-client testing)" + }, + { + "concept": "41a9a67e-ce27-4a33-be91-0725209c69b0", + "label": "KP (Key population)" + }, + { + "concept": "8d560b25-6860-44fb-bf16-d21672435c6d", + "label": "SNS (Social network strategy)" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other" + } + ] + } + }, + { + "label": "Entry point (Service delivery point for HIV testing)", + "type": "obs", + "required": false, + "id": "entryPoint", + "questionOptions": { + "rendering": "radio", + "concept": "1201b688-45f8-4e56-b089-0b31138a19dd", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "TB" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "OPD1" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "OPD2" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "OPD3" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "OPD4" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "STI" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Derma" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Pedi OPD1" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Pedi OPD2" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Malnutrition" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other OPD" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "VCT" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "ANC Client" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "ANC Partner" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "L&D Client" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "L&D Partner" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "PNC Client" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "PNC Partner" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "HEI" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Medical Ward" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Pedi Ward" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Gyn Ward" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "ICT Children" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "ICT Partner" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Outreach testing" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Referred from community" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Public HF" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Private HF" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "NGO" + } + ] + }, + "validators": [] + }, + { + "label": "Priority Criteria", + "type": "obs", + "required": false, + "id": "priorityCriteria", + "questionOptions": { + "rendering": "multiCheckbox", + "concept": "8534a956-49e8-42d9-82c4-33e51429265d", + "conceptMappings": [], + "answers": [ + { + "concept": "bde58790-d3fc-40d6-bcce-f728105f91cf", + "label": "PLHIV (People living with HIV) restart ART & adult" + }, + { + "concept": "c1c0c92c-521c-454c-bfd2-52db5b308f6a", + "label": "PLHIV (People living with HIV) incare with STI" + }, + { + "concept": "4693bef1-4d6b-4546-b2c9-1a3409b6158f", + "label": "Newly diagnosed" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other" + }, + { + "concept": "41a9a67e-ce27-4a33-be91-0725209c69b0", + "label": "KP (Key population)" + }, + { + "concept": "cd44c2af-e628-455f-8826-7aab004bd100", + "label": "Enrolled at PMTCT (Prevention of mother-to-child transmission of HIV)" + }, + { + "concept": "f21b86a8-95b6-4ef6-ad36-d6f9ee92e1d9", + "label": "30" + } + ] + } + }, + { + "label": "Target population", + "type": "obs", + "required": false, + "id": "targetPopulation", + "questionOptions": { + "rendering": "multiCheckbox", + "concept": "ca2c04ba-d9bd-4bad-ab03-e57ea9e49016", + "conceptMappings": [], + "answers": [ + { + "concept": "e916113e-8d95-43f5-a07c-a21a8aca9bed", + "label": "Children of PLHIV (People living with HIV)" + }, + { + "concept": "166430AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "General population" + }, + { + "concept": "162198AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Long distance truck driver" + }, + { + "concept": "9fb6c25b-4765-463b-9f26-7cc3addf1105", + "label": "Mobile worker/Daily laborer" + }, + { + "concept": "2453316b-2e88-43d7-87c9-32ef4725ec5d", + "label": "Other MARPS-Wido-Divo-Sepa" + }, + { + "concept": "b696f324-05a5-49ba-8577-6172195473fc", + "label": "OVC (Orphans and vulnerable children)" + }, + { + "concept": "360d3b35-4946-454c-86e6-815fed0723f2", + "label": "Partner of PLHIV (People living with HIV)" + }, + { + "concept": "e53cf0d0-86ed-4b20-aa93-58546b970c63", + "label": "Prisoners" + } + ] + } + }, + { + "label": "HIV test date", + "type": "obs", + "required": false, + "id": "hivTestDate", + "questionOptions": { + "rendering": "date", + "concept": "164400AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "164400" + } + ], + "answers": [] + } + }, + { + "label": "ART status", + "type": "obs", + "required": false, + "id": "artStatus", + "questionOptions": { + "rendering": "radio", + "concept": "944db041-06ff-4775-8739-540c74e8e0f7", + "conceptMappings": [], + "answers": [ + { + "concept": "7e305664-b939-4a24-bf7b-2d533cd16b0a", + "label": "Tested HIV+ (HIV Positive)" + }, + { + "concept": "ed799b96-4e99-4abd-ac9d-87670bcf050c", + "label": "Started" + }, + { + "concept": "167156AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Refused" + }, + { + "concept": "5b0bd7f0-6792-4e9b-b250-7589ffc4db0b", + "label": "Referred" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other" + }, + { + "concept": "f6ce58c8-1346-48ab-8f62-74edd9b8a7b7", + "label": "On OI management" + }, + { + "concept": "d0409cbe-1932-446a-a2d6-149922204080", + "label": "On adherence preparation" + }, + { + "concept": "160034AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Died" + } + ] + } + }, + { + "label": "ART start date", + "type": "obs", + "required": false, + "id": "artStartDate", + "questionOptions": { + "rendering": "date", + "concept": "159599AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "NARROWER-THAN", + "type": "AMPATH", + "value": "5869" + }, + { + "relationship": "NARROWER-THAN", + "type": "AMPATH", + "value": "1499" + }, + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "2516" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "159599" + }, + { + "relationship": "SAME-AS", + "type": "PIH-Malawi", + "value": "2516" + }, + { + "relationship": "NARROWER-THAN", + "type": "SNOMED-CT", + "value": "413946009" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-MVP", + "value": "1595991000105005" + } + ], + "answers": [] + } + }, + { + "label": "UAN", + "type": "obs", + "required": false, + "id": "uan", + "questionOptions": { + "rendering": "text", + "concept": "c8d98ef1-5e58-417c-a7c3-7f30f76a7155", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "164402" + } + ], + "answers": [] + } + }, + { + "label": "If not, reasons", + "type": "obs", + "required": false, + "id": "artNotInitiated", + "questionOptions": { + "rendering": "radio", + "concept": "0692893e-95bd-4749-a7fe-b0ca96a79407", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Referred" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Declined" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Died" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Known +ve" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "On adherence" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "On OIs" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other, specify" + } + ] + }, + "validators": [] + }, + { + "label": "Plan for next step", + "type": "obs", + "required": false, + "id": "planForNextStep", + "questionOptions": { + "rendering": "radio", + "concept": "1201b688-45f8-4e56-b089-0b31138a19dd", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Linked to case managers for further counseling and tracking" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Address adherence barriers" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Initiate ART when the patient is ready after OI manaagement" + } + ] + }, + "validators": [] + }, + { + "label": "Outcome of non-initiated clients", + "type": "obs", + "required": false, + "id": "outcomeOfNoninitiatedClients", + "questionOptions": { + "rendering": "radio", + "concept": "1201b688-45f8-4e56-b089-0b31138a19dd", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Started ART" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Declined" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Died" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Confirmed referral and started ART in other facility" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Lost to follow up" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other" + } + ] + }, + "validators": [] + }, + { + "label": "Is CRF completed?", + "type": "obs", + "required": false, + "id": "crf", + "questionOptions": { + "rendering": "radio", + "concept": "f387c69d-ccb0-4f5b-b260-c51e23a491d9", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Test for recency", + "type": "obs", + "required": false, + "id": "testForRecency", + "questionOptions": { + "rendering": "radio", + "concept": "63ffc936-492f-4ee3-b24e-d6d8a72674a9", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Recency result", + "type": "obs", + "required": false, + "id": "recencyResult", + "questionOptions": { + "rendering": "radio", + "concept": "3e0c5f07-cea4-4da5-8091-854c4d343bc0", + "conceptMappings": [], + "answers": [ + { + "concept": "07896600-8646-4f15-9a5b-92593ee5008f", + "label": "IR (Incident/Intermittent Infection)" + }, + { + "concept": "c0b85e2c-8c7e-456e-a0d5-1280c8bfa7d4", + "label": "LT (Long-Term Infection)" + }, + { + "concept": "165090AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Recent" + } + ] + } + }, + { + "label": "Case classification", + "type": "obs", + "required": false, + "id": "caseClassification", + "questionOptions": { + "rendering": "radio", + "concept": "165793AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "NARROWER-THAN", + "type": "SNOMED-CT", + "value": "406221003" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "165793" + } + ], + "answers": [ + { + "concept": "165792AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Confirmed present" + }, + { + "concept": "162863AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Probable" + }, + { + "concept": "162743AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Suspected" + }, + { + "concept": "1067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Unknown" + } + ] + } + }, + { + "label": "Is index TI?", + "type": "obs", + "required": false, + "id": "indexTi", + "questionOptions": { + "rendering": "radio", + "concept": "0f7f772e-90e1-4980-a448-178a46111df7", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Screened for AE", + "type": "obs", + "required": false, + "id": "screenedForAE", + "questionOptions": { + "rendering": "radio", + "concept": "cfb99cde-34ba-4c6b-b89c-df5672ceb138", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Adverse event type", + "type": "obs", + "required": false, + "id": "adverseEventType", + "questionOptions": { + "rendering": "radio", + "concept": "e0e6d06a-fec6-4ae9-aec5-6d2ffda07f40", + "conceptMappings": [], + "answers": [ + { + "concept": "1058AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Divorced" + }, + { + "concept": "8da00bae-4655-46ba-b442-e3ca50b8bf96", + "label": "Job loss" + }, + { + "concept": "807fa6a8-a2ff-45db-9b41-72949fd9401d", + "label": "Loneliness" + }, + { + "concept": "74f8c5a5-be94-4605-947f-2eb2cac3c187", + "label": "Loss of relationship" + }, + { + "concept": "c405b20b-0845-4721-b09b-d067fd36a594", + "label": "Loss of support" + }, + { + "concept": "b47f53d9-e053-4caf-ac1e-f7fee48d89fc", + "label": "No AE (Adverse event)" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other" + }, + { + "concept": "152292AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Physical Abuse" + }, + { + "concept": "159524AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Sexual abstinence" + }, + { + "concept": "0f27a4b6-5f19-4c44-9d6d-abcdd9fd8d30", + "label": "Stigma" + }, + { + "concept": "0ef9b5ba-8690-4c63-8b38-ed9a6a263a39", + "label": "Taking away access to children" + }, + { + "concept": "a9cd93c0-fcd4-46d3-80aa-12d1a74fc8d4", + "label": "Verbal abuse" + } + ] + } + }, + { + "label": "Linked to App. service", + "type": "obs", + "required": false, + "id": "linkedToApp", + "questionOptions": { + "rendering": "radio", + "concept": "bb6e58c7-2691-4f22-9b6f-4d45e3606184", + "conceptMappings": [], + "answers": [] + } + } + ] + } + ] + } + ] +} \ No newline at end of file diff --git a/src/forms/ict-offer/1.0.json b/src/forms/ict-offer/1.0.json new file mode 100644 index 00000000..0c56987e --- /dev/null +++ b/src/forms/ict-offer/1.0.json @@ -0,0 +1,139 @@ +{ + "name": "POC ICT Offer", + "version": "1.0", + "published": true, + "retired": false, + "encounter": "ICT Offer", + "processor": "EncounterFormProcessor", + "referencedForms": [], + "uuid": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", + "encounterType": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", + "allowUnspecifiedAll": true, + "pages": [ + { + "label": "POC ICT Offer", + "sections": [ + { + "label": "ICT Offer", + "isExpanded": "true", + "questions": [ + { + "label": "ICT Offer", + "type": "obsGroup", + "questionOptions": { + "rendering": "repeating", + "concept": "28883ff4-ce1f-4adc-a893-927d2b4b4f91" + }, + "id": "ictOffer", + "questions": [ + { + "label": "Offered", + "type": "obs", + "required": false, + "id": "offered", + "questionOptions": { + "rendering": "radio", + "concept": "eef33554-8844-48ed-abec-a06e4918b7fe", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Offered date", + "type": "obs", + "required": false, + "id": "offeredDate", + "questionOptions": { + "rendering": "date", + "concept": "a7c606b1-9f3e-4095-815a-3a623dc738e1", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "Accepted", + "type": "obs", + "required": false, + "id": "accepted", + "questionOptions": { + "rendering": "radio", + "concept": "fdcbadef-40c5-486a-a30b-a88477ab90ae", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Accepted date", + "type": "obs", + "required": false, + "id": "acceptedDate", + "questionOptions": { + "rendering": "date", + "concept": "da8e65a1-04ee-44a0-be4b-d2bc4f002aa4", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "If not accepted, indicate", + "type": "obs", + "required": false, + "id": "notAccepted", + "questionOptions": { + "rendering": "multiCheckbox", + "concept": "59fa6f41-a1d0-45bc-af79-643b2e7dcd23", + "conceptMappings": [], + "answers": [ + { + "concept": "3c2c53ec-efa8-4254-bb0c-202c4bb9d750", + "label": "Afraid IPV" + }, + { + "concept": "015d54ca-e4e8-4165-880a-c8a14cf9e714", + "label": "No data source" + }, + { + "concept": "12283dd2-ec9d-4a41-b672-1076eb1c2858", + "label": "No family members" + }, + { + "concept": "8611a257-6b96-464f-8ae2-410c9c692c55", + "label": "No reason" + }, + { + "concept": "7a203f1c-3ff1-492d-af7d-d804d7d1f84a", + "label": "No time for elicitation" + }, + { + "concept": "6369d2cb-bf3d-44e4-8cd3-639b40bd8ce1", + "label": "Preferred other HF" + } + ] + } + } + ] + } + ] + } + ] + } + ] +} \ No newline at end of file diff --git a/src/forms/ict/1.0.json b/src/forms/ict/1.0.json deleted file mode 100644 index d3246be9..00000000 --- a/src/forms/ict/1.0.json +++ /dev/null @@ -1,1841 +0,0 @@ -{ - "name": "POC Index Case Testing", - "version": "1.0", - "published": true, - "retired": false, - "encounter": "Index Case Testing", - "processor": "EncounterFormProcessor", - "referencedForms": [], - "uuid": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", - "encounterType": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", - "allowUnspecifiedAll": true, - "pages": [ - { - "label": "POC Index Case Testing", - "sections": [ - { - "label": "ICT General", - "isExpanded": "true", - "questions": [ - { - "label": "Date linked", - "type": "obs", - "required": false, - "id": "dateLinked", - "questionOptions": { - "rendering": "date", - "concept": "5fff58c8-705d-4e4a-954e-41e7441c659d", - "conceptMappings": [], - "answers": [] - } - }, - { - "label": "ICT Serial Number", - "type": "obs", - "required": true, - "id": "ictNumber", - "questionOptions": { - "rendering": "text", - "concept": "b35f9632-9ff8-410f-bfcb-f497023bbcf9", - "conceptMappings": [], - "answers": [] - } - }, - { - "label": "Index first name", - "type": "obs", - "required": false, - "id": "indexFirstName", - "questionOptions": { - "rendering": "text", - "concept": "166102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "SAME-AS", - "type": "PIH", - "value": "2725" - }, - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "166102" - }, - { - "relationship": "SAME-AS", - "type": "SNOMED-CT", - "value": "408677003" - } - ], - "answers": [] - }, - "validators": [] - }, - { - "label": "Index middle name", - "type": "obs", - "required": false, - "id": "indexMiddleName", - "questionOptions": { - "rendering": "text", - "concept": "166574AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "SAME-AS", - "type": "SNOMED-CT", - "value": "716057004" - }, - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "166574" - } - ], - "answers": [] - }, - "validators": [] - }, - { - "label": "Index last name", - "type": "obs", - "required": false, - "id": "indexLastName", - "questionOptions": { - "rendering": "text", - "concept": "166103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "SAME-AS", - "type": "PIH", - "value": "2724" - }, - { - "relationship": "SAME-AS", - "type": "SNOMED-CT", - "value": "397678008" - }, - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "166103" - } - ], - "answers": [] - }, - "validators": [] - }, - { - "label": "Marital status", - "type": "obs", - "required": false, - "id": "maritalStatus", - "questionOptions": { - "rendering": "radio", - "concept": "1054AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "SAME-AS", - "type": "AMPATH", - "value": "1054" - }, - { - "relationship": "SAME-AS", - "type": "PIH-Malawi", - "value": "1054" - }, - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "1054" - }, - { - "relationship": "SAME-AS", - "type": "PIH-Malawi", - "value": "1054" - }, - { - "relationship": "SAME-AS", - "type": "AMPATH", - "value": "1054" - }, - { - "relationship": "SAME-AS", - "type": "PIH", - "value": "3350" - }, - { - "relationship": "SAME-AS", - "type": "SNOMED-CT", - "value": "365581002" - }, - { - "relationship": "SAME-AS", - "type": "PIH", - "value": "3350" - }, - { - "relationship": "SAME-AS", - "type": "SNOMED-CT", - "value": "365581002" - } - ], - "answers": [ - { - "concept": "1058AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Divorced" - }, - { - "concept": "135704AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Lives alone" - }, - { - "concept": "1060AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Living with partner" - }, - { - "concept": "5555AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Married" - }, - { - "concept": "1057AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Never married" - }, - { - "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Other non-coded" - }, - { - "concept": "1056AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Separated" - }, - { - "concept": "1059AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Widowed" - } - ] - }, - "validators": [] - }, - { - "label": "Do you know about HIVST?", - "type": "obs", - "required": false, - "id": "hivst", - "questionOptions": { - "rendering": "radio", - "concept": "6949f032-06d5-4019-abce-dba4bb46e192", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] - } - }, - { - "label": "If yes, have you ever recommended your friends for HIVST?", - "type": "obs", - "required": false, - "id": "recommendedHivst", - "questionOptions": { - "rendering": "radio", - "concept": "0bc4754a-473f-4929-826e-8b11bee4ea0e", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] - } - }, - { - "label": "Have you ever tested using HIVST?", - "type": "obs", - "required": false, - "id": "testedUsingHivst", - "questionOptions": { - "rendering": "radio", - "concept": "166464AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "166464" - }, - { - "relationship": "SAME-AS", - "type": "KenyaEMR", - "value": "164952" - } - ], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - }, - { - "concept": "1067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Unknown" - } - ] - } - }, - { - "label": "Case finding strategy", - "type": "obs", - "required": false, - "id": "caseFindingStrategy", - "questionOptions": { - "rendering": "radio", - "concept": "f81ddad3-ba72-4670-91d4-1dbed708958b", - "conceptMappings": [], - "answers": [ - { - "concept": "9d0e9067-33a0-4d14-ad18-0baa4eab4297", - "label": "PICT (Provider-initiated counseling and testing)" - }, - { - "concept": "160539AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Voluntary counseling and testing program" - }, - { - "concept": "160526AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Early Infant Diagnosis Visit" - } - ] - } - }, - { - "label": "If PICT,", - "type": "obs", - "required": false, - "id": "ifPict", - "questionOptions": { - "rendering": "radio", - "concept": "e5d1cf7c-d14a-49d2-bbdc-621804269115", - "conceptMappings": [], - "answers": [ - { - "concept": "6b4d8d21-a278-4649-963f-985025b28806", - "label": "ANC (Absolute neutrophil count)" - }, - { - "concept": "afcd8ca6-4706-4a0f-8d3b-bb46781a1698", - "label": "HRST (HIV risk screening tool)" - }, - { - "concept": "ca7df214-3fef-48d6-b8d7-16da8e921c4c", - "label": "ICT (Index-client testing)" - }, - { - "concept": "41a9a67e-ce27-4a33-be91-0725209c69b0", - "label": "KP (Key population)" - }, - { - "concept": "8d560b25-6860-44fb-bf16-d21672435c6d", - "label": "SNS (Social network strategy)" - }, - { - "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Other" - } - ] - } - }, - { - "label": "Entry point (Service delivery point for HIV testing)", - "type": "obs", - "required": false, - "id": "entryPoint", - "questionOptions": { - "rendering": "radio", - "concept": "1201b688-45f8-4e56-b089-0b31138a19dd", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "TB" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "OPD1" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "OPD2" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "OPD3" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "OPD4" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "STI" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Derma" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Pedi OPD1" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Pedi OPD2" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Malnutrition" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Other OPD" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "VCT" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "ANC Client" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "ANC Partner" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "L&D Client" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "L&D Partner" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "PNC Client" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "PNC Partner" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "HEI" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Medical Ward" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Pedi Ward" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Gyn Ward" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "ICT Children" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "ICT Partner" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Outreach testing" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Referred from community" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Public HF" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Private HF" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "NGO" - } - ] - }, - "validators": [] - }, - { - "label": "Priority Criteria", - "type": "obs", - "required": false, - "id": "priorityCriteria", - "questionOptions": { - "rendering": "multiCheckbox", - "concept": "8534a956-49e8-42d9-82c4-33e51429265d", - "conceptMappings": [], - "answers": [ - { - "concept": "bde58790-d3fc-40d6-bcce-f728105f91cf", - "label": "PLHIV (People living with HIV) restart ART & adult" - }, - { - "concept": "c1c0c92c-521c-454c-bfd2-52db5b308f6a", - "label": "PLHIV (People living with HIV) incare with STI" - }, - { - "concept": "4693bef1-4d6b-4546-b2c9-1a3409b6158f", - "label": "Newly diagnosed" - }, - { - "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Other" - }, - { - "concept": "41a9a67e-ce27-4a33-be91-0725209c69b0", - "label": "KP (Key population)" - }, - { - "concept": "cd44c2af-e628-455f-8826-7aab004bd100", - "label": "Enrolled at PMTCT (Prevention of mother-to-child transmission of HIV)" - }, - { - "concept": "f21b86a8-95b6-4ef6-ad36-d6f9ee92e1d9", - "label": "30" - } - ] - } - }, - { - "label": "Target population", - "type": "obs", - "required": false, - "id": "targetPopulation", - "questionOptions": { - "rendering": "multiCheckbox", - "concept": "ca2c04ba-d9bd-4bad-ab03-e57ea9e49016", - "conceptMappings": [], - "answers": [ - { - "concept": "e916113e-8d95-43f5-a07c-a21a8aca9bed", - "label": "Children of PLHIV (People living with HIV)" - }, - { - "concept": "166430AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "General population" - }, - { - "concept": "162198AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Long distance truck driver" - }, - { - "concept": "9fb6c25b-4765-463b-9f26-7cc3addf1105", - "label": "Mobile worker/Daily laborer" - }, - { - "concept": "2453316b-2e88-43d7-87c9-32ef4725ec5d", - "label": "Other MARPS-Wido-Divo-Sepa" - }, - { - "concept": "b696f324-05a5-49ba-8577-6172195473fc", - "label": "OVC (Orphans and vulnerable children)" - }, - { - "concept": "360d3b35-4946-454c-86e6-815fed0723f2", - "label": "Partner of PLHIV (People living with HIV)" - }, - { - "concept": "e53cf0d0-86ed-4b20-aa93-58546b970c63", - "label": "Prisoners" - } - ] - } - }, - { - "label": "HIV test date", - "type": "obs", - "required": false, - "id": "hivTestDate", - "questionOptions": { - "rendering": "date", - "concept": "164400AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "164400" - } - ], - "answers": [] - } - }, - { - "label": "ART status", - "type": "obs", - "required": false, - "id": "artStatus", - "questionOptions": { - "rendering": "radio", - "concept": "944db041-06ff-4775-8739-540c74e8e0f7", - "conceptMappings": [], - "answers": [ - { - "concept": "7e305664-b939-4a24-bf7b-2d533cd16b0a", - "label": "Tested HIV+ (HIV Positive)" - }, - { - "concept": "ed799b96-4e99-4abd-ac9d-87670bcf050c", - "label": "Started" - }, - { - "concept": "167156AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Refused" - }, - { - "concept": "5b0bd7f0-6792-4e9b-b250-7589ffc4db0b", - "label": "Referred" - }, - { - "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Other" - }, - { - "concept": "f6ce58c8-1346-48ab-8f62-74edd9b8a7b7", - "label": "On OI management" - }, - { - "concept": "d0409cbe-1932-446a-a2d6-149922204080", - "label": "On adherence preparation" - }, - { - "concept": "160034AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Died" - } - ] - } - }, - { - "label": "ART start date", - "type": "obs", - "required": false, - "id": "artStartDate", - "questionOptions": { - "rendering": "date", - "concept": "159599AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "NARROWER-THAN", - "type": "AMPATH", - "value": "5869" - }, - { - "relationship": "NARROWER-THAN", - "type": "AMPATH", - "value": "1499" - }, - { - "relationship": "SAME-AS", - "type": "PIH", - "value": "2516" - }, - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "159599" - }, - { - "relationship": "SAME-AS", - "type": "PIH-Malawi", - "value": "2516" - }, - { - "relationship": "NARROWER-THAN", - "type": "SNOMED-CT", - "value": "413946009" - }, - { - "relationship": "SAME-AS", - "type": "SNOMED-MVP", - "value": "1595991000105005" - } - ], - "answers": [] - } - }, - { - "label": "UAN", - "type": "obs", - "required": false, - "id": "uan", - "questionOptions": { - "rendering": "text", - "concept": "c8d98ef1-5e58-417c-a7c3-7f30f76a7155", - "conceptMappings": [ - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "164402" - } - ], - "answers": [] - } - }, - { - "label": "If not, reasons", - "type": "obs", - "required": false, - "id": "artNotInitiated", - "questionOptions": { - "rendering": "radio", - "concept": "0692893e-95bd-4749-a7fe-b0ca96a79407", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Referred" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Declined" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Died" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Known +ve" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "On adherence" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "On OIs" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Other, specify" - } - ] - }, - "validators": [] - }, - { - "label": "Plan for next step", - "type": "obs", - "required": false, - "id": "planForNextStep", - "questionOptions": { - "rendering": "radio", - "concept": "1201b688-45f8-4e56-b089-0b31138a19dd", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Linked to case managers for further counseling and tracking" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Address adherence barriers" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Initiate ART when the patient is ready after OI manaagement" - } - ] - }, - "validators": [] - }, - { - "label": "Outcome of non-initiated clients", - "type": "obs", - "required": false, - "id": "outcomeOfNoninitiatedClients", - "questionOptions": { - "rendering": "radio", - "concept": "1201b688-45f8-4e56-b089-0b31138a19dd", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Started ART" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Declined" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Died" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Confirmed referral and started ART in other facility" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Lost to follow up" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Other" - } - ] - }, - "validators": [] - }, - { - "label": "Is CRF completed?", - "type": "obs", - "required": false, - "id": "crf", - "questionOptions": { - "rendering": "radio", - "concept": "f387c69d-ccb0-4f5b-b260-c51e23a491d9", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] - } - }, - { - "label": "Test for recency", - "type": "obs", - "required": false, - "id": "testForRecency", - "questionOptions": { - "rendering": "radio", - "concept": "63ffc936-492f-4ee3-b24e-d6d8a72674a9", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] - } - }, - { - "label": "Recency result", - "type": "obs", - "required": false, - "id": "recencyResult", - "questionOptions": { - "rendering": "radio", - "concept": "3e0c5f07-cea4-4da5-8091-854c4d343bc0", - "conceptMappings": [], - "answers": [ - { - "concept": "07896600-8646-4f15-9a5b-92593ee5008f", - "label": "IR (Incident/Intermittent Infection)" - }, - { - "concept": "c0b85e2c-8c7e-456e-a0d5-1280c8bfa7d4", - "label": "LT (Long-Term Infection)" - }, - { - "concept": "165090AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Recent" - } - ] - } - }, - { - "label": "Case classification", - "type": "obs", - "required": false, - "id": "caseClassification", - "questionOptions": { - "rendering": "radio", - "concept": "165793AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "conceptMappings": [ - { - "relationship": "NARROWER-THAN", - "type": "SNOMED-CT", - "value": "406221003" - }, - { - "relationship": "SAME-AS", - "type": "CIEL", - "value": "165793" - } - ], - "answers": [ - { - "concept": "165792AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Confirmed present" - }, - { - "concept": "162863AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Probable" - }, - { - "concept": "162743AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Suspected" - }, - { - "concept": "1067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Unknown" - } - ] - } - }, - { - "label": "Is index TI?", - "type": "obs", - "required": false, - "id": "indexTi", - "questionOptions": { - "rendering": "radio", - "concept": "0f7f772e-90e1-4980-a448-178a46111df7", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] - } - 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}, - { - "label": "ICT Offer", - "isExpanded": "true", - "questions": [ - { - "label": "ICT Offer", - "type": "obsGroup", - "questionOptions": { - "rendering": "repeating", - "concept": "28883ff4-ce1f-4adc-a893-927d2b4b4f91" - }, - "id": "ictOffer", - "questions": [ - { - "label": "Offered", - "type": "obs", - "required": false, - "id": "offered", - "questionOptions": { - "rendering": "radio", - "concept": "eef33554-8844-48ed-abec-a06e4918b7fe", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] - } - }, - { - "label": "Offered date", - "type": "obs", - "required": false, - "id": "offeredDate", - "questionOptions": { - "rendering": "date", - "concept": "a7c606b1-9f3e-4095-815a-3a623dc738e1", - "conceptMappings": [], - "answers": [] - } - }, - { - "label": "Accepted", - "type": "obs", - "required": false, - "id": "accepted", - 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"72750cad-0b54-4875-97c7-c94fb9caa50e", - "conceptMappings": [], - "answers": [] - } - }, - { - "label": "PrEP eligibility", - "type": "obs", - "required": false, - "id": "prepEligibility", - "questionOptions": { - "rendering": "radio", - "concept": "7c63f6ab-62c3-4e2b-a679-bba109c645d3", - "conceptMappings": [], - "answers": [ - { - "concept": "8875cb57-a667-474d-9f9b-d3e592dfc75b", - "label": "Eligible (E)" - }, - { - "concept": "b64e1eea-9dc4-4149-8644-646980d2ab4b", - "label": "Not eligible (NE)" - } - ] - } - }, - { - "label": "Started oral PrEP", - "type": "obs", - "required": false, - "id": "startedOralPrep", - "questionOptions": { - "rendering": "radio", - "concept": "301bb015-75a2-4074-b3aa-fb4bfa89ca57", - "conceptMappings": [], - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] - } - }, - { - "label": "Date oral PrEP started", - "type": "obs", - "required": false, - "id": "dateOralPrepStarted", - "questionOptions": { - "rendering": "date", - "concept": "5810b330-1003-4619-9e4f-c8a1f25fd12c", - "conceptMappings": [], - "answers": [] - } - } - ] - } - ] - } - ] - } - ] -} \ No newline at end of file diff --git a/src/forms/index-contact-followup/1.0.json b/src/forms/index-contact-followup/1.0.json new file mode 100644 index 00000000..1e681f83 --- /dev/null +++ b/src/forms/index-contact-followup/1.0.json @@ -0,0 +1,704 @@ +{ + "name": "POC Index Case Testing", + "version": "1.0", + "published": true, + "retired": false, + "encounter": "Index Contact Followup", + "processor": "EncounterFormProcessor", + "referencedForms": [], + "uuid": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", + "encounterType": "bf097a70-4bb8-47dc-a127-1aacf86a86a0", + "allowUnspecifiedAll": true, + "pages": [ + { + "label": "POC Index Contact Followup", + "sections": [ + { + "label": "Index Contact Followup", + "isExpanded": "true", + "questions": [ + { + "label": "Index Case Contact Followup", + "type": "obsGroup", + "questionOptions": { + "rendering": "repeating", + "concept": "391a9e9e-40e9-11ee-be56-0242ac120002" + }, + "id": "contactFollowup", + "questions": [ + { + "label": "Elicited date", + "type": "obs", + "required": false, + "id": "elicitedDate", + "questionOptions": { + "rendering": "date", + "concept": "58abd286-8f57-4717-aa41-efd8e93d5902", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "Reason contact elicited", + "type": "obs", + "required": false, + "id": "reasonContactElicited", + "questionOptions": { + "rendering": "radio", + "concept": "ed179dd4-d0fa-4b84-bb55-0dc4b1c42615", + "conceptMappings": [], + "answers": [ + { + "concept": "cd44c2af-e628-455f-8826-7aab004bd100", + "label": "Enrolled at PMTCT (Prevention of mother-to-child transmission of HIV)" + }, + { + "concept": "4693bef1-4d6b-4546-b2c9-1a3409b6158f", + "label": "Newly diagnosed" + }, + { + "concept": "c1c0c92c-521c-454c-bfd2-52db5b308f6a", + "label": "PLHIV (People living with HIV) incare with STI" + }, + { + "concept": "bde58790-d3fc-40d6-bcce-f728105f91cf", + "label": "PLHIV (People living with HIV) restart ART & adult" + }, + { + "concept": "7b370f0a-61e2-4cc4-99c1-f38d96d7cee0", + "label": "PLHIV (People living with HIV) with HVL & adult" + } + ] + } + }, + { + "label": "Current test date", + "type": "obs", + "required": false, + "id": "currentTestDate", + "questionOptions": { + "rendering": "date", + "concept": "76b355ac-5708-4e2e-ab5c-7b21d5c62405", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "Current result", + "type": "obs", + "required": false, + "id": "currentResult", + "questionOptions": { + "rendering": "radio", + "concept": "fee36db1-6b65-4625-b1ac-6290716f39b7", + "conceptMappings": [], + "answers": [ + { + "concept": "165649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Inconclusive" + }, + { + "concept": "664AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Negative" + }, + { + "concept": 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"duplicateElicitation", + "questionOptions": { + "rendering": "radio", + "concept": "96bccc1e-606c-423f-b592-03a762e6df98", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Contact first name", + "type": "obs", + "required": false, + "id": "contactFirstName", + "questionOptions": { + "rendering": "text", + "concept": "166102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "2725" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166102" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "408677003" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Contact middle name", + "type": "obs", + "required": false, + "id": "contactMiddleName", + "questionOptions": { + "rendering": "text", + "concept": "166574AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "716057004" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166574" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Contact last name", + "type": "obs", + "required": false, + "id": "contactLastName", + "questionOptions": { + "rendering": "text", + "concept": "166103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "2724" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "397678008" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166103" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Contact birth date", + "type": "obs", + "required": false, + "id": "contactBirthDate", + "questionOptions": { + "rendering": "date", + "concept": "166575AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "166575" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "184099003" + } + ], + "answers": [] + } + }, + { + "label": "Gender", + "type": "obs", + "required": false, + "id": "contactGender", + "questionOptions": { + "rendering": "radio", + "concept": "1533AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "LOINC", + "value": "72143-4" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "1533" + } + ], + "answers": [ + { + "concept": "1535AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Female gender" + }, + { + "concept": "1534AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Male gender" + }, + { + "concept": "1067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Unknown" + } + ] + }, + "validators": [] + }, + { + "label": "Contact category", + "type": "obs", + "required": false, + "id": "contactCategory", + "questionOptions": { + "rendering": "radio", + "concept": "a7d17e7a-a8b2-49b5-84f1-aade1277b658", + "conceptMappings": [], + "answers": [ + { + "concept": "5c306c62-1141-47c5-8754-b5dfbd0bbe48", + "label": "Child less than 19 years" + }, + { + "concept": "1527AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Parent" + }, + { + "concept": "a79a78a5-e983-4a1d-986c-6868a04da28e", + "label": "Partner" + }, + { + "concept": "972AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Sibling" + } + ] + } + }, + { + "label": "Is IPV risk assessed", + "type": "obs", + "required": false, + "id": "ipvRisk", + "questionOptions": { + "rendering": "radio", + "concept": "bf64b919-2e57-4f96-82c8-7d551b506181", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "IPV risk outcome", + "type": "obs", + "required": false, + "id": "ipvRiskOutcome", + "questionOptions": { + "rendering": "multiCheckbox", + "concept": "d9843fda-3799-4727-8695-02292f4a90b4", + "conceptMappings": [], + "answers": [ + { + "concept": "fe881e9b-fafe-4f06-936b-22cd20165044", + "label": "No IPV (Intimate Partner Violence)" + }, + { + "concept": "152292AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Physical Abuse" + }, + { + "concept": "152370AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Sexual abuse" + }, + { + "concept": "61712cf4-7898-4b38-a202-6d68a83dbf01", + "label": "NA child" + }, + { + "concept": "118668AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Emotional Trouble" + } + ] + } + }, + { + "label": "Is linked to PGBV", + "type": "obs", + "required": false, + "id": "linkedToPgbv", + "questionOptions": { + "rendering": "radio", + "concept": "5fdc49a5-18fd-4817-8270-9e5b4f47c62f", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Notification plan", + "type": "obs", + "required": false, + "id": "notificationPlan", + "questionOptions": { + "rendering": "radio", + "concept": "4d789ec1-9ea9-4b5e-bc27-a0611c4f8310", + "conceptMappings": [], + "answers": [ + { + "concept": "013a416d-b517-415d-aba2-e7dbae5014b1", + "label": "Client" + }, + { + "concept": "19785c69-e16c-412a-af3f-5a77979c99ff", + "label": "Contractual" + }, + { + "concept": "d53de30f-62a5-454a-a5f9-215b803b2122", + "label": "Dual" + }, + { + "concept": "9e67687f-5df5-43c1-acd0-134295791541", + "label": "No plan" + }, + { + "concept": "c74f4c43-c85a-43f0-87a2-2554178ab714", + "label": "NR" + }, + { + "concept": "f7dcfbd8-d3fb-4a95-a321-fa6d8e9a7212", + "label": "Provider" + } + ] + } + }, + { + "label": "Contact phone number", + "type": "obs", + "required": false, + "id": "contactPhoneNumber", + "questionOptions": { + "rendering": "text", + "concept": "159635AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "159635" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "184103008" + }, + { + "relationship": "SAME-AS", + "type": "org.openmrs.module.mdrtb", + "value": "TELEPHONE NUMBER" + } + ], + "answers": [] + } + }, + { + "label": "Contact trials outcome", + "type": "obs", + "required": false, + "id": "contactTrialsOutcome", + "questionOptions": { + "rendering": "radio", + "concept": "8d36d055-439b-4ad6-9744-c7720557f6cb", + "conceptMappings": [], + "answers": [ + { + "concept": "c739c10c-76a0-4100-8696-0e878e6e11ee", + "label": "Appointed to come" + }, + { + "concept": "d62f8bf8-a0e8-4e3d-bd6c-4f5192ba1c50", + "label": "Contact me again" + }, + { + "concept": "c5dc6e3f-92dc-4083-ada1-2941e53d4331", + "label": "Declined to contact" + }, + { + "concept": "160034AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Died" + }, + { + "concept": "6369d2cb-bf3d-44e4-8cd3-639b40bd8ce1", + "label": "Preferred other HF" + }, + { + "concept": "23371695-e6c4-4cb5-9784-6c3ec161f051", + "label": "Tested" + }, + { + "concept": "8b76f2bc-5fb7-4b7b-b5bd-12c28b7aa1f2", + "label": "Unable to contact" + } + ] + } + }, + { + "label": "Tested before", + "type": "obs", + "required": false, + "id": "testedBefore", + "questionOptions": { + "rendering": "radio", + "concept": "3d91f263-262e-4e55-9e28-1484225837c6", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Prior HIV test result", + "type": "obs", + "required": false, + "id": "priorHivTestResult", + "questionOptions": { + "rendering": "radio", + "concept": "0f4be70c-f1dc-434b-acba-fc1421854bc4", + "conceptMappings": [], + "answers": [ + { + "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Positive" + }, + { + "concept": "664AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Negative" + }, + { + "concept": "165649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Inconclusive" + } + ] + } + }, + { + "label": "Prior test date (Estimated)", + "type": "obs", + "required": false, + "id": "priorTestDate", + "questionOptions": { + "rendering": "date", + "concept": "67e5e461-c1bd-44fc-8b74-5929a388df9a", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "HIVST kit distributed date", + "type": "obs", + "required": false, + "id": "hivstKit", + "questionOptions": { + "rendering": "date", + "concept": "947073ef-aa76-42cb-a361-1641149a8100", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "HIVST result", + "type": "obs", + "required": false, + "id": "hivstResult", + "questionOptions": { + "rendering": "radio", + "concept": "e77fb81b-7811-41e4-8f30-af101d9c1c6b", + "conceptMappings": [], + "answers": [ + { + "concept": "165090AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Recent" + }, + { + "concept": "c74f4c43-c85a-43f0-87a2-2554178ab714", + "label": "NR" + } + ] + } + }, + { + "label": "HIVST report date", + "type": "obs", + "required": false, + "id": "hivstReportDate", + "questionOptions": { + "rendering": "date", + "concept": "70e43194-c463-444d-a631-db938fbc1bdc", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "Contact UAN", + "type": "obs", + "required": false, + "id": "contactUan", + "questionOptions": { + "rendering": "text", + "concept": "72750cad-0b54-4875-97c7-c94fb9caa50e", + "conceptMappings": [], + "answers": [] + } + }, + { + "label": "PrEP eligibility", + "type": "obs", + "required": false, + "id": "prepEligibility", + "questionOptions": { + "rendering": "radio", + "concept": "7c63f6ab-62c3-4e2b-a679-bba109c645d3", + "conceptMappings": [], + "answers": [ + { + "concept": "8875cb57-a667-474d-9f9b-d3e592dfc75b", + "label": "Eligible (E)" + }, + { + "concept": "b64e1eea-9dc4-4149-8644-646980d2ab4b", + "label": "Not eligible (NE)" + } + ] + } + }, + { + "label": "Started oral PrEP", + "type": "obs", + "required": false, + "id": "startedOralPrep", + "questionOptions": { + "rendering": "radio", + "concept": "301bb015-75a2-4074-b3aa-fb4bfa89ca57", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "Date oral PrEP started", + "type": "obs", + "required": false, + "id": "dateOralPrepStarted", + "questionOptions": { + "rendering": "date", + "concept": "5810b330-1003-4619-9e4f-c8a1f25fd12c", + "conceptMappings": [], + "answers": [] + } + } + ] + } + ] + } + ] + } + ] +} \ No newline at end of file