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Create CommunityPharmacyEnrollment.json (#753)
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configuration/ampathforms/CommunityPharmacyEnrollment.json
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| { | ||
| "name": "CPM Enrollment Form", | ||
| "description": "Community Pharmacy Model Enrollment form", | ||
| "version": "1.1", | ||
| "published": true, | ||
| "uuid": "f01c67f7-2293-4a6a-b0f6-5db0fb5934dd", | ||
| "retired": false, | ||
| "encounter": "CPM Enrollment Encounter", | ||
| "meta": { | ||
| "programs": { | ||
| "uuid": "8cd42506-2ebd-485f-89d6-4bb9ed328ccc", | ||
| "isEnrollment": true, | ||
| "enrollmentDateQuestionId": "" | ||
| } | ||
| }, | ||
| "pages": [ | ||
| { | ||
| "label": "Visit Details", | ||
| "sections": [ | ||
| { | ||
| "label": "Encounter Details", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Enrolment 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": "Eligibility Checklist ", | ||
| "sections": [ | ||
| { | ||
| "label": "ROC Details", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "ROC Current ART Regimen duration (Months)", | ||
| "type": "obs", | ||
| "id": "ARTiNMonths", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "concept": "1553AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "number" | ||
| }, | ||
| "alert": { | ||
| "alertWhenExpression": "parseInt(ARTiNMonths) <= 5", | ||
| "message": "ROC is not Eligible for CPM program" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Is the ROC on TB treatment in the previous 6 months?", | ||
| "type": "obs", | ||
| "required": "true", | ||
| "id": "language", | ||
| "questionOptions": { | ||
| "rendering": "radio", | ||
| "concept": "166665AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "answers": [ | ||
| { | ||
| "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Yes" | ||
| }, | ||
| { | ||
| "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "No" | ||
| } | ||
| ] | ||
| }, | ||
| "validators": [], | ||
| "hide": { | ||
| "hideWhenExpression": "" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Has the ROC been adherent to the scheduled clinic visits within the last 6 months", | ||
| "type": "obs", | ||
| "required": "true", | ||
| "id": "ARTSixMonths", | ||
| "questionOptions": { | ||
| "rendering": "radio", | ||
| "concept": "162703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "answers": [ | ||
| { | ||
| "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Yes" | ||
| }, | ||
| { | ||
| "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "No" | ||
| } | ||
| ] | ||
| }, | ||
| "validators": [], | ||
| "hide": { | ||
| "hideWhenExpression": "" | ||
| } | ||
| }, | ||
| { | ||
| "label": "What is the VL result within the last 6months", | ||
| "type": "obs", | ||
| "required": "true", | ||
| "id": "IndicateVLDate", | ||
| "questionOptions": { | ||
| "rendering": "radio", | ||
| "concept": "166664AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "answers": [ | ||
| { | ||
| "concept": "acdae6ac-0a51-407b-884a-3ee6a0924d0a", | ||
| "label": "<200(Copies/ml)" | ||
| }, | ||
| { | ||
| "concept": "68bfa3f3-1fc7-4d9d-bb41-e897c3c430ef", | ||
| "label": "LDL" | ||
| } | ||
| ] | ||
| }, | ||
| "hide": { | ||
| "hideWhenExpression": "" | ||
| } | ||
| } | ||
| ] | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "label": "Declarations", | ||
| "sections": [ | ||
| { | ||
| "lael": "Clinician and ROC Declaration", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Is the recipient of care (ROC) established on care as defined in the ART guidelines?", | ||
| "type": "obs", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "rendering": "radio", | ||
| "concept": "ccf759b9-bdd4-4265-a71a-67a894d89dec", | ||
| "answers": [ | ||
| { | ||
| "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Yes" | ||
| }, | ||
| { | ||
| "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "No" | ||
| } | ||
| ] | ||
| }, | ||
| "id": "ROConsent", | ||
| "hide": { | ||
| "hideWhenExpression": "age < 15" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Is the ROC eligible for Community Pharmacy Model approach?", | ||
| "type": "obs", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "rendering": "radio", | ||
| "concept": "162697AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "answers": [ | ||
| { | ||
| "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Yes" | ||
| }, | ||
| { | ||
| "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "No" | ||
| } | ||
| ] | ||
| }, | ||
| "id": "eligibeYesNo", | ||
| "hide": { | ||
| "hideWhenExpression": "isEmpty(ROConsent) || ROConsent !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Assent given?", | ||
| "type": "obs", | ||
| "id": "assentGiven", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "concept": "167093AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Yes" | ||
| }, | ||
| { | ||
| "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "No" | ||
| } | ||
| ] | ||
| }, | ||
| "hide": { | ||
| "hideWhenExpression": "age > 18 || isEmpty(ROConsent) || ROConsent !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" | ||
| } | ||
| }, | ||
| { | ||
| "label": "If Yes - Parent/ Guardian Consent given? ", | ||
| "type": "obs", | ||
| "id": "ParenTConsent", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "concept": "162696AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Yes" | ||
| }, | ||
| { | ||
| "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "No" | ||
| } | ||
| ] | ||
| }, | ||
| "hide": { | ||
| "hideWhenExpression": "assentGiven !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Has the ROC given consent for CPM Enrollment", | ||
| "type": "obs", | ||
| "id": "consentGiven", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "concept": "1710AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "true", | ||
| "label": "Yes" | ||
| }, | ||
| { | ||
| "concept": "false", | ||
| "label": "No" | ||
| } | ||
| ] | ||
| }, | ||
| "hide": { | ||
| "hideWhenExpression": "age < 18 || isEmpty(ROConsent) || ROConsent !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" | ||
| } | ||
| } | ||
| ] | ||
| } | ||
| ] | ||
| } | ||
| ], | ||
| "encounterType": "e0700664-90b6-4480-aad2-6e0a00babd66" | ||
| } |