diff --git a/distro/configuration/ampathforms/ui_select_extended_test_v1.0.json b/distro/configuration/ampathforms/ui_select_extended_test_v1.0.json
new file mode 100644
index 000000000..9bd9d9f61
--- /dev/null
+++ b/distro/configuration/ampathforms/ui_select_extended_test_v1.0.json
@@ -0,0 +1,64 @@
+{
+    "name": "UI-Select-Extended Test",
+    "version": "1.0",
+    "published": true,
+    "retired": false,
+    "encounter": "UI select extended test",
+    "pages": [
+      {
+        "label": "Page 1",
+        "sections": [
+          {
+            "label": "Section 1",
+            "isExpanded": "true",
+            "questions": [
+              {
+                "label": "Test Text",
+                "type": "obs",
+                "required": false,
+                "id": "test_text",
+                "questionOptions": {
+                  "rendering": "text",
+                  "concept": "161011AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
+                  "conceptMappings": [
+                    {
+                      "relationship": "SAME-AS",
+                      "type": "CIEL",
+                      "value": "161011"
+                    }
+                  ],
+                  "answers": []
+                },
+                "validators": []
+              },
+                  {
+                "label": "Provider",
+                "type": "obs",
+                "id": "encounter_provider",
+                "questionOptions": {
+                  "concept": "5619AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
+                  "rendering": "ui-select-extended",
+                  "datasource": "encounter-provider"
+                },
+                "behaviours":[
+                  {
+                    "intent":"*",
+                    "required":"true",
+                    "unspecified":"true",
+                    "hide":{
+                      "hideWhenExpression":"false"
+                    }
+                  }
+                ]
+              }
+            ]
+          }
+        ]
+      }
+    ],
+    "processor": "EncounterFormProcessor",
+    "encounterType": "111c2104-991d-4b58-a30e-ce84bb275534",
+    "referencedForms": [],
+    "uuid": "4ba0e45a-a614-4b90-9b77-2b7ee26380bb",
+    "description": "Test"
+  }
\ No newline at end of file
diff --git a/distro/configuration/encountertypes/encountertypes.csv b/distro/configuration/encountertypes/encountertypes.csv
index 8436f3410..c87e55b4e 100644
--- a/distro/configuration/encountertypes/encountertypes.csv
+++ b/distro/configuration/encountertypes/encountertypes.csv
@@ -41,3 +41,4 @@ a221448d-512b-4750-84bf-d29be9f802b3,,HIV Program Status,To hold computed Obs fo
 6dc5308d-27c9-4d49-b16f-2c5e3c759757,,Labor and Delivery,Labor and delivery visit by a mother,,,
 4362fd2d-1866-4ea0-84ef-5e5da9627440,,Postnatal,Post natal visit by a mother,,,
 f3d92c68-27e3-4395-b002-5db5f3ca4ef7,,HIV Exposed Infant,HIV Exposed Infant encounter,,,
+f9b52289-3d6d-4a87-ae45-d014d64c8693,,UI select extended test,UI select extended test,,,
\ No newline at end of file