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@icap-ethiopia/esm-ethiohri-app

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{ "name": "POC ICT Offer", "version": "1.0", "published": true, "retired": false, "encounter": "ICT Offer", "processor": "EncounterFormProcessor", "referencedForms": [], "uuid": "23b08733-6d26-48b5-bict-general25e1e", "encounterType": "23b08733-6d26-48b5-b135-dac294e25e1e", "allowUnspecifiedAll": true, "pages": [ { "label": "ICT SERVICE OFFERING", "sections": [ { "label": "ICT SERVICE OFFERING", "isExpanded": "true", "questions": [ { "label": "Visit date", "type": "obs", "required": false, "id": "visitDate", "questionOptions": { "rendering": "date", "concept": "53097498-c1b3-49d0-a159-ee09b4b5a914", "conceptMappings": [], "answers": [] } }, { "label": "Prioritization for ICT", "type": "obs", "required": false, "id": "priorityCriteria", "questionOptions": { "rendering": "checkbox", "concept": "8534a956-49e8-42d9-82c4-33e51429265d", "conceptMappings": [], "answers": [ { "concept": "4693bef1-4d6b-4546-b2c9-1a3409b6158f", "label": "Newly Diagnosed" }, { "concept": "7b370f0a-61e2-4cc4-99c1-f38d96d7cee0", "label": "PLHIV with HVL & Adult" }, { "concept": "bde58790-d3fc-40d6-bcce-f728105f91cf", "label": "PLHIV restart ART & Adult" }, { "concept": "c1c0c92c-521c-454c-bfd2-52db5b308f6a", "label": "PLHIV incare with STI" }, { "concept": "cd44c2af-e628-455f-8826-7aab004bd100", "label": "Enrolled at PMTCT" }, { "concept": "41a9a67e-ce27-4a33-be91-0725209c69b0", "label": "Key population" }, { "concept": "a30f0bd7-c81c-4f5d-9d9c-12afb084e005", "label": "Client with new partner" }, { "concept": "c2881eae-b745-499f-872a-62f3a270d793", "label": "Client with partner not yet disclosed" }, { "concept": "62b44258-b73b-4362-a0bc-f90703ed6d38", "label": "Client with partner not tested" }, { "concept": "dd0515e2-abe7-457e-bc6a-b7faf14aeecb", "label": "Client child (<15 Years) not tested" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] }, "validators": [] }, { "label": "Specify other", "type": "obs", "questionOptions": { "rendering": "text", "concept": "373c74c7-0957-487f-a7a1-e086857c5fb7" }, "hide": { "hideWhenExpression": "!includes('priorityCriteria','5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA')" }, "id": "otherPrioritization" }, { "label": "Offered", "type": "obs", "required": false, "id": "offered", "questionOptions": { "rendering": "radio", "concept": "eef33554-8844-48ed-abec-a06e4918b7fe", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Offered date", "type": "obs", "required": false, "hide": { "hideWhenExpression": "offered !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "offeredDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "a7c606b1-9f3e-4095-815a-3a623dc738e1", "conceptMappings": [], "answers": [] } }, { "label": "Accepted", "type": "obs", "required": false, "id": "accepted", "hide": { "hideWhenExpression": "offered !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "questionOptions": { "rendering": "radio", "concept": "fdcbadef-40c5-486a-a30b-a88477ab90ae", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Accepted date", "type": "obs", "required": false, "hide": { "hideWhenExpression": "accepted !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "acceptedDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "da8e65a1-04ee-44a0-be4b-d2bc4f002aa4", "conceptMappings": [], "answers": [] } }, { "label": "Elicited", "type": "obs", "required": false, "id": "elicited", "hide": { "hideWhenExpression": "accepted !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "questionOptions": { "rendering": "radio", "concept": "77296687-cba5-4e70-9d51-e20e54d50548", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Reason ICT service not accepted", "type": "obs", "required": false, "hide": { "hideWhenExpression": "accepted !== '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "notAccepted", "questionOptions": { "rendering": "checkbox", "concept": "59fa6f41-a1d0-45bc-af79-643b2e7dcd23", "conceptMappings": [], "answers": [ { "concept": "8611a257-6b96-464f-8ae2-410c9c692c55", "label": "No reason" }, { "concept": "7a203f1c-3ff1-492d-af7d-d804d7d1f84a", "label": "No time" }, { "concept": "53384cd2-dff0-4db2-b403-78bd3d8903cd", "label": "Fear of disclosure" }, { "concept": "3c2c53ec-efa8-4254-bb0c-202c4bb9d750", "label": "Afraid of IPV" }, { "concept": "6369d2cb-bf3d-44e4-8cd3-639b40bd8ce1", "label": "Prefer other HF" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Specify other reason", "type": "obs", "questionOptions": { "rendering": "text", "concept": "f39fc7e2-0485-43dc-9d22-b065850710c8" }, "hide": { "hideWhenExpression": "!includes('notAccepted','5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA')" }, "id": "otherReason" } ] }, { "label": "IPV/AE", "isExpanded": "true", "questions": [ { "label": "High risk for IPV", "type": "obs", "required": false, "id": "highRiskIpv", "questionOptions": { "rendering": "radio", "concept": "6cb09073-5bc1-4cbb-a13c-27c98956231b", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "AE reported", "type": "obs", "required": false, "id": "aeReported", "questionOptions": { "rendering": "radio", "concept": "ff68acf5-9a2f-44c9-a2a3-fa8807dcb04a", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Adverse event type", "type": "obs", "required": false, "id": "adverseEventType", "questionOptions": { "rendering": "checkbox", "concept": "e0e6d06a-fec6-4ae9-aec5-6d2ffda07f40", "conceptMappings": [], "answers": [ { "concept": "1058AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Divorce" }, { "concept": "74f8c5a5-be94-4605-947f-2eb2cac3c187", "label": "Loss of relationship" }, { "concept": "c405b20b-0845-4721-b09b-d067fd36a594", "label": "Loss of support" }, { "concept": "0f27a4b6-5f19-4c44-9d6d-abcdd9fd8d30", "label": "Stigma" }, { "concept": "8da00bae-4655-46ba-b442-e3ca50b8bf96", "label": "Job loss" }, { "concept": "158835AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Social exclusion" }, { "concept": "a9cd93c0-fcd4-46d3-80aa-12d1a74fc8d4", "label": "Verbal abuse" }, { "concept": "152292AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Physical abuse" }, { "concept": "807fa6a8-a2ff-45db-9b41-72949fd9401d", "label": "Loneliness" }, { "concept": "159524AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Cessation of sexual intercourse" }, { "concept": "134660AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Marital discord" }, { "concept": "0ef9b5ba-8690-4c63-8b38-ed9a6a263a39", "label": "Taking away access to children" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Specify other type", "type": "obs", "questionOptions": { "rendering": "text", "concept": "37002efb-7044-47b4-bcbc-d900161fc7ee" }, "hide": { "hideWhenExpression": "!includes('adverseEventType','5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA')" }, "id": "otherType" }, { "label": " Linked to appropriate care", "type": "obs", "required": false, "id": "linkedToApp", "questionOptions": { "rendering": "radio", "concept": "f4817ca2-a67f-46e3-8c97-864612ccbb47", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "validators": [] } ] } ] } ], "availableIntents": [ { "intent": "*", "display": "default_intent" } ] }