From 56a7ae8ea8d822f7d5f7d3842991482ac4cf02e6 Mon Sep 17 00:00:00 2001
From: Kote Cosmas <110154947+ckote@users.noreply.github.com>
Date: Fri, 6 Sep 2024 13:59:29 +0300
Subject: [PATCH] Create CommunityPharmacyEnrollment.json (#753)

---
 .../CommunityPharmacyEnrollment.json          | 283 ++++++++++++++++++
 1 file changed, 283 insertions(+)
 create mode 100644 configuration/ampathforms/CommunityPharmacyEnrollment.json

diff --git a/configuration/ampathforms/CommunityPharmacyEnrollment.json b/configuration/ampathforms/CommunityPharmacyEnrollment.json
new file mode 100644
index 00000000..eafa0b09
--- /dev/null
+++ b/configuration/ampathforms/CommunityPharmacyEnrollment.json
@@ -0,0 +1,283 @@
+{
+  "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"
+}