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distro/configuration/ampathforms/Contact Tracing Form - test.json
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distro/configuration/ampathforms/GOO1 DRC Clinical Visit Form v2.2.json
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distro/configuration/ampathforms/GOO1 DRC HIV Enrolment Form v1.2.json
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distro/configuration/ampathforms/GOO1 DRC HIV Enrolment Form v1.3.1.json
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distro/configuration/ampathforms/GOO1 DRC HIV Enrolment Form v1.3.json
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distro/configuration/ampathforms/GP002-ART Therapy Form.json
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distro/configuration/ampathforms/GP002-DRC Clinical Visit Form v2.2.json
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distro/configuration/ampathforms/GP002-Patient Tracing Form.json
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distro/configuration/ampathforms/GP002-Service Delivery Model Form.json
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{ | ||
"name": "GP002-Service Delivery Model Form", | ||
"version": "1", | ||
"published": true, | ||
"retired": false, | ||
"pages": [ | ||
{ | ||
"label": "Service Delivery Model", | ||
"sections": [ | ||
{ | ||
"label": "Introduction", | ||
"isExpanded": "true", | ||
"questions": [ | ||
{ | ||
"type": "markdown", | ||
"questionOptions": { | ||
"rendering": "markdown" | ||
}, | ||
"id": "fooMarkdown", | ||
"value": [ | ||
"**This form is used to:** Document differentiated service deliver enrolment/ disenrolment." | ||
] | ||
} | ||
] | ||
}, | ||
{ | ||
"label": "DSD Enrollment", | ||
"isExpanded": "true", | ||
"questions": [ | ||
{ | ||
"label": "Date enrolled to DSD", | ||
"type": "obs", | ||
"required": true, | ||
"id": "dateEnrolledToDSD", | ||
"datePickerFormat": "calendar", | ||
"questionOptions": { | ||
"rendering": "date", | ||
"concept": "160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"conceptMappings": [ | ||
{ | ||
"relationship": "SAME-AS", | ||
"type": "CIEL", | ||
"value": "160753" | ||
}, | ||
{ | ||
"relationship": "SAME-AS", | ||
"type": "SNOMED-CT", | ||
"value": "439771001" | ||
} | ||
] | ||
}, | ||
"behaviours": [ | ||
{ | ||
"intent": "*", | ||
"unspecified": "true" | ||
} | ||
], | ||
"validators": [ | ||
{ | ||
"type": "date", | ||
"allowFutureDates": "false" | ||
}, | ||
{ | ||
"type": "js_expression", | ||
"failsWhenExpression": "isDateBefore(myValue, '1980-01-01') || myValue >= today()" | ||
} | ||
] | ||
}, | ||
{ | ||
"label": "Date disenrolled from DSD", | ||
"type": "obs", | ||
"required": true, | ||
"id": "dateDisenrolledDSD", | ||
"datePickerFormat": "calendar", | ||
"questionOptions": { | ||
"rendering": "date", | ||
"concept": "160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"conceptMappings": [ | ||
{ | ||
"relationship": "SAME-AS", | ||
"type": "CIEL", | ||
"value": "160753" | ||
}, | ||
{ | ||
"relationship": "SAME-AS", | ||
"type": "SNOMED-CT", | ||
"value": "439771001" | ||
} | ||
] | ||
}, | ||
"behaviours": [ | ||
{ | ||
"intent": "*", | ||
"unspecified": "true" | ||
} | ||
], | ||
"validators": [ | ||
{ | ||
"type": "date", | ||
"allowFutureDates": "false" | ||
}, | ||
{ | ||
"type": "js_expression", | ||
"failsWhenExpression": "isDateBefore(myValue, '1980-01-01') || myValue >= today()" | ||
} | ||
] | ||
}, | ||
{ | ||
"label": "Reason for disenrolling from DSD", | ||
"type": "obs", | ||
"required": true, | ||
"questionOptions": { | ||
"rendering": "text", | ||
"concept": "163513AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" | ||
}, | ||
"id": "reasonForDiscontinuingDSD", | ||
"behaviours": [ | ||
{ | ||
"intent": "*", | ||
"unspecified": "true", | ||
"validators": [] | ||
} | ||
] | ||
} | ||
] | ||
}, | ||
{ | ||
"label": "Differentiated Service Delivery Models", | ||
"isExpanded": "true", | ||
"questions": [ | ||
{ | ||
"label": "Antiretroviral treatment refill model", | ||
"type": "obs", | ||
"required": false, | ||
"id": "facilityDSDModel", | ||
"questionOptions": { | ||
"rendering": "radio", | ||
"concept": "166448AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"conceptMappings": [ | ||
{ | ||
"relationship": "SAME-AS", | ||
"type": "KenyaEMR", | ||
"value": "164947" | ||
}, | ||
{ | ||
"relationship": "SAME-AS", | ||
"type": "CIEL", | ||
"value": "166448" | ||
}, | ||
{ | ||
"relationship": "NARROWER-THAN", | ||
"type": "SNOMED CT", | ||
"value": "363819003" | ||
} | ||
], | ||
"answers": [ | ||
{ | ||
"concept": "166443AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "Community medication distribution, healthcare worker led" | ||
}, | ||
{ | ||
"concept": "166444AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "Community medication distribution, peer led" | ||
}, | ||
{ | ||
"concept": "166446AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "Express pharmacy pickup without clinician visit" | ||
}, | ||
{ | ||
"concept": "166445AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "Facility group medication distribution" | ||
}, | ||
{ | ||
"concept": "166447AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "Standard pharmacy pickup following clinician visit" | ||
} | ||
] | ||
} | ||
}, | ||
{ | ||
"label": "Enrollment", | ||
"type": "obs", | ||
"required": false, | ||
"id": "enrollment", | ||
"questionOptions": { | ||
"rendering": "select", | ||
"concept": "83e40f2c-c316-43e6-a12e-20a338100281", | ||
"conceptMappings": [ | ||
{ | ||
"relationship": "SAME-AS", | ||
"type": "CIEL", | ||
"value": "160555" | ||
} | ||
], | ||
"answers": [ | ||
{ | ||
"concept": "164144AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "New client" | ||
}, | ||
{ | ||
"concept": "159833AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "re-enroll" | ||
}, | ||
{ | ||
"concept": "8c61710e-f431-4e0a-8ccf-933385a79ba6", | ||
"label": "Referred from EMTCT" | ||
}, | ||
{ | ||
"concept": "160563AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"label": "Transfer in" | ||
} | ||
] | ||
} | ||
} | ||
], | ||
"behaviours": [ | ||
{ | ||
"intent": "*", | ||
"unspecified": "true" | ||
} | ||
] | ||
}, | ||
{ | ||
"label": "Notes", | ||
"isExpanded": "true", | ||
"questions": [ | ||
{ | ||
"label": "Comments", | ||
"type": "obs", | ||
"questionOptions": { | ||
"rendering": "textarea", | ||
"concept": "165095AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
"rows": "", | ||
"conceptMappings": [ | ||
{ | ||
"type": "CIEL", | ||
"value": "165095" | ||
} | ||
] | ||
}, | ||
"id": "dSDNotes" | ||
} | ||
] | ||
} | ||
] | ||
} | ||
], | ||
"availableIntents": [ | ||
{ | ||
"intent": "*", | ||
"display": "Service Delivery Model" | ||
} | ||
], | ||
"processor": "EncounterFormProcessor", | ||
"uuid": "d345e966-0c91-4e89-a9b1-c4dd04a35243", | ||
"referencedForms": [], | ||
"encounterType": "62ee5922-a229-48d3-a1da-875c1ffa9436", | ||
"encounter": "Service Delivery Model Form", | ||
"allowUnspecifiedAll": true, | ||
"description": "Document differentiated service deliver enrolment/ disenrolment" | ||
} |
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