From 7032505bc4558e8e34df549343c790cf16fc77e5 Mon Sep 17 00:00:00 2001 From: AJAL ODORA JONATHAN <43242517+ODORA0@users.noreply.github.com> Date: Mon, 22 Jan 2024 12:56:56 +0300 Subject: [PATCH] OHRI-2114 Add TPT FollowUp Form --- .../tpt_followup_and_treatment_v1.0.json | 467 +++++++++++++++++- 1 file changed, 466 insertions(+), 1 deletion(-) diff --git a/distro/configuration/ampathforms/tpt_followup_and_treatment_v1.0.json b/distro/configuration/ampathforms/tpt_followup_and_treatment_v1.0.json index bd83109de..6844c020c 100644 --- a/distro/configuration/ampathforms/tpt_followup_and_treatment_v1.0.json +++ b/distro/configuration/ampathforms/tpt_followup_and_treatment_v1.0.json @@ -1,10 +1,475 @@ { "name": "TPT Followup & Treatment form", + "pages": [ + { + "label": "TPT Treatment Followup", + "sections": [ + { + "label": "Visit Details", + "isExpanded": "true", + "questions": [ + { + "label": "Case ID", + "type": "obs", + "required": false, + "id": "caseID", + "questionOptions": { + "rendering": "text", + "concept": "162576AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "162576" + } + ], + "answers": [] + }, + "validators": [] + } + ] + }, + { + "label": "TB Screening", + "isExpanded": "true", + "questions": [ + { + "label": "Screened for TB?", + "type": "obs", + "required": false, + "id": "screenedForTB", + "questionOptions": { + "rendering": "radio", + "concept": "c0661c0f-348b-4941-812b-c531a0a67f2e", + "conceptMappings": [], + "answers": [ + { + "concept": "664AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Negative" + }, + { + "concept": "662edd6a-9f8a-4dfa-9956-a6ec42018c72", + "label": "Presumptive Tuberculosis" + }, + { + "concept": "166519AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Screening not done" + }, + { + "concept": "159798AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "currently on tuberculosis treatment" + }, + { + "concept": "166449AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Currently taking tuberculosis prophylaxis" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "Investigations", + "isExpanded": "true", + "questions": [ + { + "label": "Tuberculosis test type", + "type": "obs", + "required": false, + "id": "tbTestType", + "questionOptions": { + "rendering": "radio", + "concept": "165254AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "165254" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Tuberculosis test type", + "type": "obs", + "required": false, + "id": "testType", + "questionOptions": { + "rendering": "select", + "concept": "165254AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "165254" + } + ], + "answers": [ + { + "concept": "164945AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "GeneXpert MTB/Rif Lab set" + }, + { + "concept": "159961AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "tuberculosis smear microscopy method" + }, + { + "concept": "12AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "X-ray, chest" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "TPT Adherence", + "isExpanded": "true", + "questions": [ + { + "label": "Overall treatment adherence", + "type": "obs", + "required": false, + "id": "adherenceTPT", + "questionOptions": { + "rendering": "radio", + "concept": "164075AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [], + "answers": [ + { + "concept": "164076AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Excellent" + }, + { + "concept": "159406AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Fair" + }, + { + "concept": "159405AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Good" + }, + { + "concept": "159407AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Poor" + }, + { + "concept": "1067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Unknown" + }, + { + "concept": "164077AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Very good" + } + ] + }, + "validators": [] + }, + { + "label": " Reason for poor Adherence", + "type": "obs", + "required": false, + "id": "reasonForPoorAdherence", + "questionOptions": { + "rendering": "select", + "concept": "160582AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "160582" + }, + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "3140" + } + ], + "answers": [ + { + "concept": "121725AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Alcohol abuse" + }, + { + "concept": "819AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Cannot afford treatment" + }, + { + "concept": "160589AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Concerned about privacy/stigma" + }, + { + "concept": "119537AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Depression" + }, + { + "concept": "102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Toxicity, drug" + }, + { + "concept": "160588AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Pill burden" + }, + { + "concept": "160583AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Shares medications with others" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other non-coded" + }, + { + "concept": "1754AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Medications unavailable" + }, + { + "concept": "160584AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Lost or ran out of medication" + }, + { + "concept": "160585AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Felt too ill to take medication" + }, + { + "concept": "160587AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Forgot to take medication" + }, + { + "concept": "160586AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Felt better and stopped taking medication" + }, + { + "concept": "820AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Transport problems" + }, + { + "concept": "1778AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Treatment or procedure not carried out due to fear of side effects" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "Adverse Drug Reaction to TPT", + "isExpanded": "true", + "questions": [ + { + "label": "Reaction to TPT", + "type": "obs", + "required": false, + "id": "reactionToTPT", + "questionOptions": { + "rendering": "select", + "concept": "160646AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [], + "answers": [ + { + "concept": "148888AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Anaphylaxis" + }, + { + "concept": "142412AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Diarrhea" + }, + { + "concept": "138111AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Hyperuricaemia" + }, + { + "concept": "137162AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Influenza-like symptoms" + }, + { + "concept": "5978AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Nausea" + }, + { + "concept": "114736AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Optic Neuritis" + }, + { + "concept": "133073AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Neurotoxicity" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other non-coded" + }, + { + "concept": "131103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Ototoxicity" + }, + { + "concept": "118983AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Peripheral neuropathy" + }, + { + "concept": "512AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Rash" + }, + { + "concept": "141600AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Shortness of breath" + }, + { + "concept": "159098AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Toxic liver disease" + }, + { + "concept": "122983AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Vomiting" + } + ] + }, + "validators": [] + }, + { + "label": "Severity of ADR", + "type": "obs", + "required": false, + "id": "severityADR", + "questionOptions": { + "rendering": "select", + "concept": "162642AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "SNOMED CT", + "value": "405162009" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "162642" + } + ], + "answers": [ + { + "concept": "162693AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Life threatening severity" + }, + { + "concept": "1498AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Mild" + }, + { + "concept": "1499AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Moderate" + }, + { + "concept": "1107AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "None" + }, + { + "concept": "1500AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Severe" + } + ] + }, + "validators": [] + }, + { + "label": "Date of Onset", + "type": "obs", + "required": false, + "id": "dateOfOnset", + "questionOptions": { + "rendering": "date", + "concept": "81a50873-81c8-4c2e-8892-b2cd635b704c", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + }, + { + "label": "Action Taken", + "type": "obs", + "required": false, + "id": "actionTaken", + "questionOptions": { + "rendering": "text", + "concept": "164378AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + } + ] + }, + { + "label": "Tuberculosis Prophylaxis plan", + "isExpanded": "true", + "questions": [ + { + "label": "Prophylaxis plan", + "type": "obs", + "required": false, + "id": "prophylaxisPlan", + "questionOptions": { + "rendering": "radio", + "concept": "1265AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [], + "answers": [ + { + "concept": "1257AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Continue regimen" + }, + { + "concept": "1260AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Stop all" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "Appointment", + "isExpanded": "true", + "questions": [ + { + "label": "Return visit Date", + "type": "obs", + "required": false, + "id": "returnVisitDate", + "questionOptions": { + "rendering": "date", + "concept": "5096AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "5096" + }, + { + "relationship": "SAME-AS", + "type": "AMPATH", + "value": "5096" + } + ], + "answers": [] + }, + "validators": [] + } + ] + } + ] + } + ], + "processor": "EncounterFormProcessor", + "referencedForms": [], "published": true, "retired": false, "encounter": "TPT Treatment and Follow-up", "encounterType": "1ac3de3f-8fc2-43a7-addb-e805c393ecae", "uuid": "118f4512-f5b2-4d0f-9dc2-a2d0165790c0", - "description": "This form captures followup information for a TB preventative treatment (TPT) client", + "description": "This form captures followup information for a TB preventative treatment (TPT) client ", "version": "1.0" }