diff --git a/configuration/ampathforms/ART_Preparation.json b/configuration/ampathforms/ART_Preparation.json index 6997ab59..fb2e513d 100644 --- a/configuration/ampathforms/ART_Preparation.json +++ b/configuration/ampathforms/ART_Preparation.json @@ -47,324 +47,324 @@ ] }, { + "label": "Psychosocial/Knowledge Criteria (applies to patients and caregivers)", + "isExpanded": "true", + "questions": [ + { "label": "Psychosocial/Knowledge Criteria (applies to patients and caregivers)", - "isExpanded": "true", + "type": "obsGroup", + "questionOptions": { + "concept": "160525AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "group" + }, "questions": [ { - "label": "Psychosocial/Knowledge Criteria (applies to patients and caregivers)", - "type": "obsGroup", + "label": "1. Understands the nature of HIV infection and benefits of ART", + "type": "obs", + "id": "__u5EvqMroL", "questionOptions": { - "concept": "160525AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "group" - }, - "questions": [ - { - "label": "1. Understands the nature of HIV infection and benefits of ART", - "type": "obs", - "id": "__u5EvqMroL", - "questionOptions": { - "concept": "1729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + "concept": "1729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "2. Has screened negative for alcohol or other drug use disorder, or is stable on treatment", - "type": "obs", - "id": "__xzL8CGsIJ", - "questionOptions": { - "concept": "160246AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "2. Has screened negative for alcohol or other drug use disorder, or is stable on treatment", + "type": "obs", + "id": "__xzL8CGsIJ", + "questionOptions": { + "concept": "160246AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "3. Has screened negative for depression or other psychiatric illness, or is stable on treatment", - "type": "obs", - "id": "__rwLEFtKyr", - "questionOptions": { - "concept": "159891AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "3. Has screened negative for depression or other psychiatric illness, or is stable on treatment", + "type": "obs", + "id": "__rwLEFtKyr", + "questionOptions": { + "concept": "159891AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "4. Is willing to disclose/has disclosed HIV status, ideally to a family member or close friend?", - "type": "obs", - "id": "__wHzDLrwnD", - "questionOptions": { - "concept": "1048AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "true", - "label": "Yes" - }, - { - "concept": "false", - "label": "No" - } - ] + ] + } + }, + { + "label": "4. Is willing to disclose/has disclosed HIV status, ideally to a family member or close friend?", + "type": "obs", + "id": "__wHzDLrwnD", + "questionOptions": { + "concept": "1048AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "true", + "label": "Yes" + }, + { + "concept": "false", + "label": "No" } - }, - { - "label": "5. Has received demonstration of how to take/administer ART and other prescribed medication?", - "type": "obs", - "id": "__12FE4wEqF", - "questionOptions": { - "concept": "164425AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "5. Has received demonstration of how to take/administer ART and other prescribed medication?", + "type": "obs", + "id": "__12FE4wEqF", + "questionOptions": { + "concept": "164425AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "6. Has received information on predictable side effects of ART and understands what steps to take in case of these side effects?", - "type": "obs", - "id": "__vvJqpxv90", - "questionOptions": { - "concept": "121764AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "true", - "label": "Yes" - }, - { - "concept": "false", - "label": "No" - } - ] + ] + } + }, + { + "label": "6. Has received information on predictable side effects of ART and understands what steps to take in case of these side effects?", + "type": "obs", + "id": "__vvJqpxv90", + "questionOptions": { + "concept": "121764AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "true", + "label": "Yes" + }, + { + "concept": "false", + "label": "No" } - }, - { - "label": "7. For patients dependent on a caregiver: caregiver is committed to long-term support of the patient, daily administration of ART, and meets the criteria above?", - "type": "obs", - "id": "__GyDHHsMwG", - "questionOptions": { - "concept": "5619AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "7. For patients dependent on a caregiver: caregiver is committed to long-term support of the patient, daily administration of ART, and meets the criteria above?", + "type": "obs", + "id": "__GyDHHsMwG", + "questionOptions": { + "concept": "5619AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "8. Other likely barriers to adherence have been identified and there is a plan in place to address them (e.g. frequent travel for work, plan to deal with unexpected travel, distance from clinic, etc)?", - "type": "obs", - "id": "__tFGMozp2p", - "questionOptions": { - "concept": "159707AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "8. Other likely barriers to adherence have been identified and there is a plan in place to address them (e.g. frequent travel for work, plan to deal with unexpected travel, distance from clinic, etc)?", + "type": "obs", + "id": "__tFGMozp2p", + "questionOptions": { + "concept": "159707AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "9. Patient/caregiver has provided accurate locator information and contact details?", - "type": "obs", - "id": "__tywCqsrEI", - "questionOptions": { - "concept": "163089AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "9. Patient/caregiver has provided accurate locator information and contact details?", + "type": "obs", + "id": "__tywCqsrEI", + "questionOptions": { + "concept": "163089AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "10. Patient/caregiver feels ready to start ART today?", - "type": "obs", - "id": "__qFFtrMuzs", - "questionOptions": { - "concept": "162695AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "10. Patient/caregiver feels ready to start ART today?", + "type": "obs", + "id": "__qFFtrMuzs", + "questionOptions": { + "concept": "162695AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - } - ], - "id": "__FztuH2z1s" + ] + } } - ] - }, + ], + "id": "__FztuH2z1s" + } + ] + }, + { + "label": "Support Systems Criteria (applies to patients and caregivers)", + "isExpanded": "true", + "questions": [ { "label": "Support Systems Criteria (applies to patients and caregivers)", - "isExpanded": "true", + "type": "obsGroup", + "questionOptions": { + "concept": "160525AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "group" + }, "questions": [ { - "label": "Support Systems Criteria (applies to patients and caregivers)", - "type": "obsGroup", + "label": "1. Has identified convenient time/s of day for taking ART, and/or associated dose/s with daily event/s?", + "type": "obs", + "id": "__oIpvnJust", "questionOptions": { - "concept": "160525AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "group" - }, - "questions": [ - { - "label": "1. Has identified convenient time/s of day for taking ART, and/or associated dose/s with daily event/s", - "type": "obs", - "id": "__oIpvnJust", - "questionOptions": { - "concept": "160119AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + "concept": "160119AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "2. Treatment supporter has been identified and engaged in HIV education, or will attend next counselling session?", - "type": "obs", - "id": "__EFoxptotp", - "questionOptions": { - "concept": "164886AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "2. Treatment supporter has been identified and engaged in HIV education, or will attend next counselling session?", + "type": "obs", + "id": "__EFoxptotp", + "questionOptions": { + "concept": "164886AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "3. Is aware of support group meeting time/s?", - "type": "obs", - "id": "__vD7LtDu3r", - "questionOptions": { - "concept": "163766AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "3. Is aware of support group meeting time/s?", + "type": "obs", + "id": "__vD7LtDu3r", + "questionOptions": { + "concept": "163766AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "4. If facility has SMS reminder system: Has enrolled into SMS reminder system?", - "type": "obs", - "id": "__otKyMFFDq", - "questionOptions": { - "concept": "163164AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "4. If facility has SMS reminder system: Has enrolled into SMS reminder system?", + "type": "obs", + "id": "__otKyMFFDq", + "questionOptions": { + "concept": "163164AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - }, - { - "label": "5. Other support systems are in place or planned (e.g. setting phone alarm, pill box)?", - "type": "obs", - "id": "__9uILLKzGD", - "questionOptions": { - "concept": "164360AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "rendering": "radio", - "answers": [ - { - "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "Yes" - }, - { - "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", - "label": "No" - } - ] + ] + } + }, + { + "label": "5. Other support systems are in place or planned (e.g. setting phone alarm, pill box)?", + "type": "obs", + "id": "__9uILLKzGD", + "questionOptions": { + "concept": "164360AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "rendering": "radio", + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" } - } - ], - "id": "__rDEzMDDsF" + ] + } } - ] + ], + "id": "__rDEzMDDsF" } + ] + } ] } ],