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configuration/ampathforms/CommunityPharmacyReferral.json
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| { | ||
| "name": "CPM Referral Form", | ||
| "description": "Community Pharmacy Model Referral form", | ||
| "version": "1", | ||
| "published": true, | ||
| "uuid": "b1e1f6fe-1894-4d06-bd8c-2b87f7cd9577", | ||
| "retired": false, | ||
| "encounter": "CPM Referral Encounter", | ||
| "pages": [ | ||
| { | ||
| "label": "Visit Details", | ||
| "sections": [ | ||
| { | ||
| "label": "Encounter Details", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Encounter 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": "Referral Details", | ||
| "sections": [ | ||
| { | ||
| "label": "Details of Pharmacy Referred to", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Name of Pharmacy", | ||
| "type": "encounterLocation", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "rendering": "ui-select-extended" | ||
| }, | ||
| "id": "nameoFCp", | ||
| "hide": { | ||
| "hideWhenExpression": "age < 15" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Contact Details", | ||
| "type": "obs", | ||
| "id": "treatmentSupportedNumber", | ||
| "questionOptions": { | ||
| "concept": "160642AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "text" | ||
| }, | ||
| "validators": [ | ||
| { | ||
| "type": "js_expression", | ||
| "failsWhenExpression": "myValue && doesNotMatchExpression('^0([0-9](?:(?:[0-9][0-9])|(?:0[0-8])|(4[0-1]))[0-9]{6})$',myValue)", | ||
| "message": "Please enter the telephone number in the correct format e.g 0713888198 thats is 10 digits" | ||
| } | ||
| ], | ||
| "hide": { | ||
| "hideWhenExpression": "age < 15" | ||
| } | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "label": "Reason for consultation", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Current ART Regimen", | ||
| "type": "obs", | ||
| "required": "true", | ||
| "questionOptions": { | ||
| "rendering": "select", | ||
| "concept": "164855AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "answers": [ | ||
| { | ||
| "concept": "162559AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "ABC/DDI/LPV/r" | ||
| }, | ||
| { | ||
| "concept": "162562AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "ABC/LPV/R/TDF" | ||
| }, | ||
| { | ||
| "concept": "161361AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "EDF/3TC/EFV" | ||
| }, | ||
| { | ||
| "concept": "792AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "D4T/3TC/NVP" | ||
| }, | ||
| { | ||
| "concept": "9fb85385-b4fb-468c-b7c1-22f75834b4b0", | ||
| "label": "TDF/3TC/DTG" | ||
| }, | ||
| { | ||
| "concept": "162200AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "3TC/ABC/LPV/r" | ||
| }, | ||
| { | ||
| "concept": "4dc0119b-b2a6-4565-8d90-174b97ba31db", | ||
| "label": "ABC/3TC/DTG" | ||
| }, | ||
| { | ||
| "concept": "164511AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "AZT-3TC-ATV/r" | ||
| }, | ||
| { | ||
| "concept": "162563AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "3TC/ABC/EFV" | ||
| }, | ||
| { | ||
| "concept": "6dec7d7d-0fda-4e8d-8295-cb6ef426878d", | ||
| "label": "AZT/3TC/DTG" | ||
| }, | ||
| { | ||
| "concept": "164505AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "TDF-3TC-EFV" | ||
| }, | ||
| { | ||
| "concept": "817AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "ABC/3TC/AZT" | ||
| }, | ||
| { | ||
| "concept": "1652AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "3TC/NVP/AZT" | ||
| }, | ||
| { | ||
| "concept": "162560AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "3TC/D4T/LPV/r" | ||
| }, | ||
| { | ||
| "concept": "162199AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "ABC/NVP/3TC" | ||
| }, | ||
| { | ||
| "concept": "164512AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "TDF-3TC-ATV/r" | ||
| }, | ||
| { | ||
| "concept": "104565AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "EFV/FTC/TDF" | ||
| }, | ||
| { | ||
| "concept": "162201AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "3TC/LPV/TDF/r" | ||
| }, | ||
| { | ||
| "concept": "162565AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "3TC/NVP/TDF" | ||
| }, | ||
| { | ||
| "concept": "162561AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "3TC/AZT/LPV/r" | ||
| }, | ||
| { | ||
| "concept": "160124AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "AZT/3TC/EFV" | ||
| }, | ||
| { | ||
| "concept": "160104AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "D4T/3TC/EFV" | ||
| } | ||
| ] | ||
| }, | ||
| "id": "currentRGX", | ||
| "hide": { | ||
| "hideWhenExpression": "age < 15" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Drug Refill Appointment", | ||
| "required": false, | ||
| "id": "appointmentWorkspaceLauncher", | ||
| "questionOptions": { | ||
| "rendering": "workspace-launcher", | ||
| "buttonLabel": "Add appointments", | ||
| "workspaceName": "appointments-form-workspace" | ||
| }, | ||
| "hide": { | ||
| "hideWhenExpression": "" | ||
| } | ||
| }, | ||
| { | ||
| "label": "Drug Order", | ||
| "required": false, | ||
| "id": "drugsWorkspaceLauncher", | ||
| "questionOptions": { | ||
| "rendering": "workspace-launcher", | ||
| "buttonLabel": "Add drug order", | ||
| "workspaceName": "add-drug-order" | ||
| }, | ||
| "hide": { | ||
| "hideWhenExpression": "" | ||
| } | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "label": "Referring Provider Details", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Cadre", | ||
| "type": "obs", | ||
| "id": "assistantCadre", | ||
| "questionOptions": { | ||
| "concept": "166014AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "162592AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "CO" | ||
| }, | ||
| { | ||
| "concept": "162591AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "MO" | ||
| }, | ||
| { | ||
| "concept": "1577AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nurse" | ||
| } | ||
| ] | ||
| } | ||
| } | ||
| ] | ||
| } | ||
| ] | ||
| } | ||
| ], | ||
| "encounterType": "c49952bf-218b-44b4-8d2a-1947cbf00fff" | ||
| } |