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@icap-ethiopia/esm-ethiohri-app

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{ "name": "POC Followup Form", "version": "1.0", "published": true, "retired": false, "encounter": "Follow Up", "pages": [ { "label": "General Information", "sections": [ { "label": "General Information", "isExpanded": "true", "questions": [ { "label": "Registration/Enrollment Date", "type": "obs", "questionOptions": { "rendering": "fixed", "concept": "1ebc345c-6f09-43e1-a616-d7e52fff4c7d", "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, 'dadc86a8-1e44-4a6d-91c2-e3b54089b54c', 'a0fde61e-f493-4f1f-b709-22aa94f72dc3'))?.valueDateTime" } }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "fixed", "concept": "1ebc345c-6f09-43e1-a616-d7e52fff4c7d" } }, { "intent": "view", "questionOptions": { "rendering": "fixed", "concept": "1ebc345c-6f09-43e1-a616-d7e52fff4c7d" } } ], "id": "enrollment_date" }, { "label": "Followup date", "type": "obs", "required": "true", "id": "followupDate", "questionOptions": { "usePreviousValueDisabled": "true", "rendering": "date", "concept": "5c118396-52dc-4cac-8860-e6d8e4a7f296", "answers": [] }, "validators": [ { "type": "date", "allowFutureDates": "false" }, { "type": "js_expression", "failsWhenExpression": "myValue < new Date(hivConfirmationDate)", "message": "Followup date should not be earlier than HIV+ Confirmation date" }, { "type": "js_expression", "failsWhenExpression": "myValue < new Date(enrollment_date)", "message": "Followup date should not be earlier than Registration date" } ] }, { "label": "Visit type", "type": "obs", "questionOptions": { "usePreviousValueDisabled": "true", "rendering": "radio", "concept": "b3f60308-cda4-41f9-af08-b98d2c1562c7", "answers": [ { "concept": "1246AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Scheduled visit" }, { "concept": "160101AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Unscheduled visit" } ] }, "id": "visitType" }, { "label": "HIV confirmation date", "type": "obs", "id": "hivConfirmationDate", "readonly": true, "questionOptions": { "concept": "160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "rendering": "date", "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, '160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA', '05add044-67f8-48c9-928d-79002ab19efe'))?.valueDateTime" } }, "behaviours": [ { "intent": "edit", "questionOptions": { "concept": "160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "rendering": "date" } }, { "intent": "view", "questionOptions": { "concept": "160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "rendering": "date" } } ], "validators": [ { "type": "date", "allowFutureDates": "false" } ] }, { "label": "Eligibility status", "type": "obs", "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, '9ed5856a-a20a-44d2-bc8e-2acaa68cf11b', '136b2ded-22a3-4831-a39a-088d35a50ef5')).then(obs => obs?.valueCodeableConcept?.coding?.map(coding => coding.code))" }, "rendering": "checkbox", "concept": "9ed5856a-a20a-44d2-bc8e-2acaa68cf11b", "answers": [ { "concept": "78dc1be4-4668-4170-b994-fc5e9a697e56", "label": "Eligible" }, { "concept": "ebd88a37-1187-4e56-8d63-2f505c6833b0", "label": "Eligible and ready" } ] }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "checkbox", "concept": "9ed5856a-a20a-44d2-bc8e-2acaa68cf11b", "answers": [ { "concept": "78dc1be4-4668-4170-b994-fc5e9a697e56", "label": "Eligible" }, { "concept": "ebd88a37-1187-4e56-8d63-2f505c6833b0", "label": "Eligible and ready" } ] } }, { "intent": "view", "questionOptions": { "rendering": "checkbox", "concept": "9ed5856a-a20a-44d2-bc8e-2acaa68cf11b", "answers": [ { "concept": "78dc1be4-4668-4170-b994-fc5e9a697e56", "label": "Eligible" }, { "concept": "ebd88a37-1187-4e56-8d63-2f505c6833b0", "label": "Eligible and ready" } ] } } ], "id": "eligibilityStatus" }, { "label": "Eligibility date", "type": "obs", "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, '162227AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueDateTime" }, "rendering": "date", "concept": "162227AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "date", "concept": "162227AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" } }, { "intent": "view", "questionOptions": { "rendering": "date", "concept": "162227AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" } } ], "validators": [ { "type": "date", "allowFutureDates": "false" }, { "type": "js_expression", "failsWhenExpression": "myValue < new Date(hivConfirmationDate)", "message": "Eligibility date should not be earlier than HIV Confirmation date in Intake A" } ], "id": "eligibleDate" }, { "label": "Transferred-In (check this for all TI cases)", "type": "obs", "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, 'cc2dfcbd-e099-47d5-b01c-74caa296ba3c', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueCodeableConcept?.coding[0]?.code" }, "rendering": "radio", "concept": "cc2dfcbd-e099-47d5-b01c-74caa296ba3c", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "radio", "concept": "cc2dfcbd-e099-47d5-b01c-74caa296ba3c", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "intent": "view", "questionOptions": { "rendering": "radio", "concept": "cc2dfcbd-e099-47d5-b01c-74caa296ba3c", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } } ], "id": "transferredInCase" }, { "label": "Why Eligible?", "type": "obs", "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, 'b7b1da64-22f4-4357-9eb8-493b43c02581', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueCodeableConcept?.coding?" }, "rendering": "checkbox", "concept": "b7b1da64-22f4-4357-9eb8-493b43c02581", "answers": [ { "concept": "b52413a8-cc05-4ce3-8af9-b4a8deda0d1b", "label": "Test and Treat", "conceptMappings": [] }, { "concept": "dfec38ad-238a-4f4a-a52f-c96b6becdd26", "label": "Clinical Staging", "conceptMappings": [] }, { "concept": "0b4ec9d0-d86a-4978-b3ad-0add037232d7", "label": "Other(like TB, HBV, Pregnant)", "conceptMappings": [] } ] }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "checkbox", "concept": "b7b1da64-22f4-4357-9eb8-493b43c02581", "answers": [ { "concept": "b52413a8-cc05-4ce3-8af9-b4a8deda0d1b", "label": "Test and Treat", "conceptMappings": [] }, { "concept": "dfec38ad-238a-4f4a-a52f-c96b6becdd26", "label": "Clinical Staging", "conceptMappings": [] }, { "concept": "0b4ec9d0-d86a-4978-b3ad-0add037232d7", "label": "Other(like TB, HBV, Pregnant)", "conceptMappings": [] } ] } }, { "intent": "view", "questionOptions": { "rendering": "checkbox", "concept": "b7b1da64-22f4-4357-9eb8-493b43c02581", "answers": [ { "concept": "b52413a8-cc05-4ce3-8af9-b4a8deda0d1b", "label": "Test and Treat", "conceptMappings": [] }, { "concept": "dfec38ad-238a-4f4a-a52f-c96b6becdd26", "label": "Clinical Staging", "conceptMappings": [] }, { "concept": "0b4ec9d0-d86a-4978-b3ad-0add037232d7", "label": "Other(like TB, HBV, Pregnant)", "conceptMappings": [] } ] } } ], "hide": { "hideWhenExpression": "transferredInCase === '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "whyEligible" }, { "label": "UAN", "type": "obs", "questionOptions": { "isTransient": true, "calculate": { "calculateExpression": "getIdentifier(patient, 'UAN')" }, "rendering": "fixed", "concept": "162054AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" }, "id": "uan" }, { "label": "ART started ?", "type": "obs", "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, '1149AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueCodeableConcept?.coding[0]?.code" }, "rendering": "radio", "concept": "1149AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "radio", "concept": "1149AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "intent": "view", "questionOptions": { "rendering": "radio", "concept": "1149AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } } ], "hide": { "hideWhenExpression": "isEmpty(uan)" }, "id": "artStarted" }, { "label": "ART start date", "type": "obs", "id": "artStartDate", "required": true, "hide": { "hideWhenExpression": "artStarted !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, 'ae329187-6232-4142-aa91-22c85bc8e5b5', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueDateTime" }, "rendering": "date", "concept": "ae329187-6232-4142-aa91-22c85bc8e5b5" }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "date", "concept": "ae329187-6232-4142-aa91-22c85bc8e5b5" } }, { "intent": "view", "questionOptions": { "rendering": "date", "concept": "ae329187-6232-4142-aa91-22c85bc8e5b5" } } ], "validators": [ { "type": "date", "allowFutureDates": "false" }, { "type": "js_expression", "failsWhenExpression": "myValue < new Date(hivConfirmationDate)", "message": "ART started date should not be earlier than HIV Confirmation date in Intake A" } ] }, { "label": "Months on ART", "type": "obs", "id": "monthsOnArt", "questionOptions": { "rendering": "text", "concept": "0503b8d4-e6db-4a87-ba42-8ef892791dba", "calculate": { "calculateExpression": "CustomMonthsOnARTCalc('artStartDate', 'followupDate')" }, "answers": [] }, "hide": { "hideWhenExpression": "artStarted !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "validators": [ { "type": "js_expression", "failsWhenExpression": "/^(\\d{4}|\\d{5}|\\d{6}|\\d{7}|\\d{8}|\\d{9})$/.test(myValue)", "message": "Months on ART should not be more than three digits long" } ] } ] } ] }, { "label": "ARV Drugs", "behaviours": [ { "intent": "*", "hide": { "hideWhenExpression": "artStarted !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' || isEmpty(uan)" } } ], "sections": [ { "label": "Followup Status", "isExpanded": "true", "questions": [ { "label": "Previous followup status", "type": "obs", "questionOptions": { "isTransient": true, "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, '222f64a8-a603-4d2e-b70e-2d90b622bb04', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueCodeableConcept?.coding[0]?.code" }, "rendering": "fixed", "concept": "" }, "hide": { "hideWhenExpression": "true" }, "id": "prevFollowupStatus" }, { "label": "Followup Status", "type": "obs", "required": true, "id": "followupStatus", "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, '222f64a8-a603-4d2e-b70e-2d90b622bb04', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueCodeableConcept?.coding[0]?.code" }, "rendering": "select", "concept": "222f64a8-a603-4d2e-b70e-2d90b622bb04", "answers": [ { "concept": "160429AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Alive on ART" }, { "concept": "162904AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Restart", "hide": { "hideWhenExpression": "prevFollowupStatus === '162904AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } }, { "concept": "159492AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "TO" }, { "concept": "1260AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Stop" }, { "concept": "27e28afa-b4a6-44e0-b331-ea7250121a0e", "label": "Lost" }, { "concept": "160431AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Drop" }, { "concept": "160432AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Dead" } ] }, "behaviours": [ { "intent": "edit", "questionOptions": { "rendering": "select", "concept": "222f64a8-a603-4d2e-b70e-2d90b622bb04", "answers": [ { "concept": "160429AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Alive on ART" }, { "concept": "162904AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Restart", "hide": { "hideWhenExpression": "prevFollowupStatus === '162904AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } }, { "concept": "159492AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "TO" }, { "concept": "1260AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Stop" }, { "concept": "27e28afa-b4a6-44e0-b331-ea7250121a0e", "label": "Lost" }, { "concept": "160431AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Drop" }, { "concept": "160432AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Dead" } ] } }, { "intent": "view", "questionOptions": { "rendering": "select", "concept": "222f64a8-a603-4d2e-b70e-2d90b622bb04", "answers": [ { "concept": "160429AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Alive on ART" }, { "concept": "162904AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Restart", "hide": { "hideWhenExpression": "prevFollowupStatus === '162904AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } }, { "concept": "159492AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "TO" }, { "concept": "1260AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Stop" }, { "concept": "27e28afa-b4a6-44e0-b331-ea7250121a0e", "label": "Lost" }, { "concept": "160431AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Drop" }, { "concept": "160432AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Dead" } ] } } ], "validators": [] }, { "label": "Reason ART regimen stopped", "type": "obs", "questionOptions": { "rendering": "checkbox", "concept": "1252AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "answers": [ { "concept": "102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Toxicity / Side effects" }, { "concept": "159598AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Poor adherence" }, { "concept": "1434AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Pregnancy" }, { "concept": "164435AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other patient decisions" }, { "concept": "160016AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Planned treatment interruption" }, { "concept": "5485AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Illness / hospitalization" }, { "concept": "843AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Treatment failure" }, { "concept": "1754AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Drugs out of stock" }, { "concept": "819AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Patient lack finances" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] }, "hide": { "hideWhenExpression": "followupStatus !== '1260AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "reasonARTRegimenStopped" } ] }, { "label": "ARV Drugs", "isExpanded": "true", "hide": { "hideWhenExpression": "followupStatus !== '160429AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' && followupStatus !== '162904AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "questions": [ { "label": "Dispense code", "type": "obs", "required": true, "id": "dispenseCode", "questionOptions": { "calculate": { "calculateExpression": "resolve(api.getLatestObs(patient.id, '6d7d0327-e1f8-4246-bfe5-be1e82d94b14', '136b2ded-22a3-4831-a39a-088d35a50ef5'))?.valueCodeableConcept?.coding[0]?.code" }, "rendering": "select", "concept": "6d7d0327-e1f8-4246-bfe5-be1e82d94b14", "answers": [ { "concept": "2798d3bc-2e0a-459c-b249-9516b380a69e", "label": "1a30 - D4T(30)+3TC+NVP", "hide": { "hideWhenExpression": "true" } }, { "concept": "3495d89f-4d46-44d8-b1c9-d101bc9f15d4", "label": "1a40 - D4T(40)+3TC+NVP", "hide": { "hideWhenExpression": "true" } }, { "concept": "ae0dc59c-eb3d-421b-913b-ee5a06ec6182", "label": "1b30 - D4T(30)+3TC+EFV", "hide": { "hideWhenExpression": "true" } }, { "concept": "c5995b5c-19bb-42f6-895b-0b4627bc9dd1", "label": "1b40 - D4T(40)+3TC+EFV", "hide": { "hideWhenExpression": "true" } }, { "concept": "a9da3e97-3916-4834-854c-6bcbc5142aca", "label": "1c - AZT+3TC+NVP", "hide": { "hideWhenExpression": "true" } }, { "concept": "b5951dd9-6bb2-4b63-af20-0707500108ea", "label": "1d - AZT+3TC+EFV" }, { "concept": "1f735bdd-4ccd-40ce-8746-28f031f38675", "label": "1e - TDF+3TC+EFV" }, { "concept": "8b727274-4a3c-4a81-ae50-9f759a87358d", "label": "1f - TDF+3TC+NVP", "hide": { "hideWhenExpression": "true" } }, { "concept": "a664a63f-57f5-4cfc-80c0-4a8456725c2a", "label": "1g - ABC+3TC+EFV" }, { "concept": "71ecf102-8d3d-4a2a-b799-30773ad5d447", "label": "1h - ABC+3TC+NVP", "hide": { "hideWhenExpression": "true" } }, { "concept": "eb171a2d-1b67-4adc-ae09-49b6d272810d", "label": "1i - Other Adult 1st line regimen" }, { "concept": "2a811ceb-3c34-47ff-943a-425b41651784", "label": "1j - TDF+3TC+DTG" }, { "concept": "c56be3a9-d678-4693-9566-84430239a2f5", "label": "1k - AZT+3TC+DTG" }, { "concept": "a87d9674-11af-4440-afd0-d097d84d0393", "label": "2a - ABC+DDL+LPV", "hide": { "hideWhenExpression": "true" } }, { "concept": "82e23d8c-4c9d-4b18-a960-9f8890b86f2f", "label": "2b - ABC+DDL+NFV", "hide": { "hideWhenExpression": "true" } }, { "concept": "cf29c24b-b796-4536-aaa5-8303f45bb5f8", "label": "2c - TDF+DDL+LPV", "hide": { "hideWhenExpression": "true" } }, { "concept": "2e84a82a-8b93-40fc-a556-2028d39f5710", "label": "2d - TDF+DDL+NFV", "hide": { "hideWhenExpression": "true" } }, { "concept": "a1056dfb-c16d-4e5c-a56b-e33228d634f8", "label": "2e - AZT+3TC+LPVr" }, { "concept": "891bf06e-298a-40ee-8970-2311d18fed48", "label": "2f - AZT+3TC+ATVr" }, { "concept": "e2d1786e-4849-473e-b32a-2c82bd35e947", "label": "2g - TDF+3TC+LPVr" }, { "concept": "a9ef6721-d2fb-4f47-bfe3-9f7902e107c7", "label": "2h - TDF+3TC+ATVr" }, { "concept": "73c10f0d-0a24-411f-9c97-49ab9e7eb2ce", "label": "2i - ABC+3TC+LPVr" }, { "concept": "2a17d96a-3457-4b93-b007-b540a7543618", "label": "2j -TDF+3TC+DTG" }, { 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