From 14d0815e16bdc56b32d1fe039b8bab455b28b52e Mon Sep 17 00:00:00 2001 From: Kote Cosmas <110154947+ckote@users.noreply.github.com> Date: Mon, 9 Sep 2024 14:25:25 +0300 Subject: [PATCH] Create CommunityPharmacyScreeningForm.json (#756) Co-authored-by: Joshua Murithi --- .../CommunityPharmacyScreeningForm.json | 532 ++++++++++++++++++ 1 file changed, 532 insertions(+) create mode 100644 configuration/ampathforms/CommunityPharmacyScreeningForm.json diff --git a/configuration/ampathforms/CommunityPharmacyScreeningForm.json b/configuration/ampathforms/CommunityPharmacyScreeningForm.json new file mode 100644 index 00000000..15131d15 --- /dev/null +++ b/configuration/ampathforms/CommunityPharmacyScreeningForm.json @@ -0,0 +1,532 @@ +{ + "name": "Community Pharmacy Screening Form", + "description": "ROC Screening Tool Community Pharmacy Form", + "version": "2.0", + "published": true, + "uuid": "f7dbe6b6-2a5a-46e6-af52-45bf2962f4aa", + "retired": false, + "encounter": "CPM Screening Encounter", + "pages": [ + { + "label": "Visit Details", + "sections": [ + { + "label": "Encounter Details", + "isExpanded": "true", + "questions": [ + { + "label": "Screening date:", + "type": "encounterDatetime", + "required": "true", + "id": "encDate", + "questionOptions": { + "rendering": "date" + }, + "validators": [ + { + "type": "date", + "allowFutureDates": "false" + } + ] + }, + { + "label": "Provider:", + "type": "encounterProvider", + "questionOptions": { + "rendering": "ui-select-extended" + }, + "id": "encProvider " + }, + { + "label": "Location:", + "type": "encounterLocation", + "questionOptions": { + "rendering": "ui-select-extended" + }, + "id": "encLocation" + } + ] + } + ] + }, + { + "label": "Screening Questions", + "sections": [ + { + "label": "Screening Questions for ROC", + "isExpanded": "true", + "questions": [ + { + "label": "Did the ROC miss their scheduled appointment for more than 7 days", + "type": "obs", + "required": "true", + "questionOptions": { + "rendering": "radio", + "concept": "ccf759b9-bdd4-4265-a71a-67a894d89dec", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "id": "ROCAppointment", + "hide": { + "hideWhenExpression": "" + } + }, + { + "label": "TB Screening Questions", + "type": "obsGroup", + "id": "scReeNiNQuiZ", + "questionOptions": { + "concept": "160108AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "group" + }, + "questions": [ + { + "label": "Cough of any duration:", + "type": "obs", + "id": "cOughDuratiOn", + "questionOptions": { + "concept": "1729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Fever:", + "type": "obs", + "id": "FeverIsh", + "questionOptions": { + "concept": "1729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Noticeable weight loss or poor weight gain:", + "type": "obs", + "id": "WeigHtLossGain", + "questionOptions": { + "concept": "1729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Night sweats:", + "type": "obs", + "id": "NighTsWeatS", + "questionOptions": { + "concept": "1729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "age < 16 || ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Contact with a TB Case:", + "type": "obs", + "id": "ConTacTbCase", + "questionOptions": { + "concept": "1729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "age > 15 || ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + } + ] + }, + { + "label": "Resulting TB Status:", + "type": "obs", + "id": "tbResultstaTuS", + "questionOptions": { + "concept": "1659AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "readOnly": "true", + "calculate": { + "calculateExpression": "((String(cOughDuratiOn) === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(FeverIsh) === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(WeigHtLossGain) === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(NighTsWeatS) === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(ConTacTbCase) === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0)) ? '142177AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' : ((String(cOughDuratiOn) === '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(FeverIsh) === '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(WeigHtLossGain) === '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(NighTsWeatS) === '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0) + (String(ConTacTbCase) === '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' ? 1 : 0)) ? '1660AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' : ''" + }, + "answers": [ + { + "concept": "1660AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No TB Signs" + }, + { + "concept": "142177AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Presumed TB" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' || (((String(cOughDuratiOn) === '159799AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'? 1 : 0) + (String(FeverIsh) === '1494AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'? 1 : 0) + (String(WeigHtLossGain) === '832AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'? 1 : 0) + (String(NighTsWeatS) === '133027AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'? 1 : 0) + (String(LeSSpLayFul) === '116334AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'? 1 : 0) + (String(ConTacTbCase) === '124068AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'? 1 : 0)) === 0)" + } + }, + { + "label": "Any signs of Jaundice", + "type": "obs", + "id": "JauNDiceSigns", + "questionOptions": { + "concept": "460AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Persistent Headache?", + "type": "obs", + "id": "HeadAches", + "questionOptions": { + "concept": "159520AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Patient had contact with TB Infected person in the last 12 months?", + "type": "obs", + "id": "contactTB", + "required": "true", + "questionOptions": { + "concept": "124068AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "alert": { + "alertWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' || tbResultstaTuS === '142177AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' || JauNDiceSigns === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' || HeadAches === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' || contactTB === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'", + "message": "Please refer the Recepient of Care back to the Health Facility" + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + } + ] + }, + { + "label": "Concurrent Medication History", + "isExpanded": "true", + "questions": [ + { + "label": "Any Medication taken before this visit", + "type": "obs", + "id": "medHis", + "questionOptions": { + "rendering": "radio", + "concept": "1628AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Past Medication History", + "type": "obsGroup", + "id": "pastprescribedDrugs", + "questionOptions": { + "concept": "1628AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "repeating" + }, + "validators": [], + "hide": { + "hideWhenExpression": "medHis !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + }, + "questions": [ + { + "label": "Drug Name", + "type": "obs", + "id": "druG", + "questionOptions": { + "concept": "162725AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "text" + } + }, + { + "label": "Dosage", + "type": "obs", + "id": "dose", + "questionOptions": { + "concept": "1443AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "number" + } + }, + { + "label": "Frequency", + "type": "obs", + "id": "frequency", + "questionOptions": { + "concept": "160855AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "select", + "answers": [ + { + "concept": "160864AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Once daily in the evening" + }, + { + "concept": "160866AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Thrice daily" + }, + { + "concept": "160862AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Once daily" + }, + { + "concept": "160865AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Once daily in the morning" + }, + { + "concept": "160863AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Once daily at bedtime" + }, + { + "concept": "160858AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Twice daily" + }, + { + "concept": "160870AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Four times daily" + } + ] + } + }, + { + "label": "Route of Adminstration", + "type": "obs", + "id": "routeOfAdmin", + "questionOptions": { + "concept": "163398AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "select", + "answers": [ + { + "concept": "160240AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Oral" + }, + { + "concept": "160242AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Intravenous" + }, + { + "concept": "160243AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Intramuscular" + }, + { + "concept": "160245AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Subcutaneous" + }, + { + "concept": "160241AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Inhalation" + }, + { + "concept": "161253AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Intranasal" + }, + { + "concept": "162391AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Transdermal" + }, + { + "concept": "162392AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Vaginally" + }, + { + "concept": "162393AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Rectally" + }, + { + "concept": "162824AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Intraosseous" + }, + { + "concept": "162391AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Transdermal" + } + ] + } + } + ] + }, + { + "label": "Use of Herbal remedies?", + "type": "obs", + "id": "herbalRemedies", + "questionOptions": { + "concept": "c67be9a5-f497-4082-af81-11753f65ed4b", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + }, + { + "label": "Skipped any pills", + "type": "obs", + "id": "SkiPPedPills", + "questionOptions": { + "concept": "159530AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "hide": { + "hideWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" + } + } + ] + } + ] + }, + { + "label": "Community Pharmacy Notes", + "sections": [ + { + "label": "Progress Notes", + "isExpanded": "true", + "questions": [ + { + "label": "Pharmacist notes", + "type": "obs", + "id": "ClinICNotes", + "questionOptions": { + "concept": "160430AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "textarea" + }, + "alert": { + "alertWhenExpression": "ROCAppointment === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'", + "message": "Please refer the Recepient of Care back to the Health Facility" + }, + "hide": { + "hideWhenExpression": "" + } + } + ] + } + ] + } + ], + "encounterType": "f0b27e6c-57cd-4dec-ad6b-43eee6e571ee" +}