@icap-ethiopia/esm-ethiohri-app

{ "name": "Family Index Case Contacts", "version": "1.0", "published": true, "retired": false, "encounter": "Follow Up", "pages": [ { "label": "Index Case", "sections": [ { "label": "Personal Information", "isExpanded": "true", "questions": [ { "label": "Registration Date", "type": "obs", "required": false, "id": "registrationDate", "datePickerFormat": "calendar", "questionOptions": { "rendering": "date", "concept": "1ebc345c-6f09-43e1-a616-d7e52fff4c7d" } }, { "label": "First Name", "type": "obs", "required": false, "id": "firstName", "questionOptions": { "rendering": "text", "concept": "166102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" } }, { "label": "Father's Name", "type": "obs", "required": false, "id": "fathersName", "questionOptions": { "rendering": "text", "concept": "166574AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" } }, { "label": "Grand Father's Name", "type": "obs", "required": false, "id": "grandfathersName", "questionOptions": { "rendering": "text", "concept": "166103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" } }, { "label": "Gender", "type": "obs", "required": false, "id": "gender", "questionOptions": { "rendering": "radio", "concept": "1533AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "answers": [ { "concept": "1534AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Male" }, { "concept": "1535AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Female" } ] } }, { "label": "Date of Birth", "type": "obs", "required": false, "id": "dateOfBirth", "questionOptions": { "rendering": "date", "concept": "e27ae70c-6131-4004-9da8-841619e19480" } }, { "label": "Age", "type": "obs", "required": false, "id": "age", "questionOptions": { "rendering": "number", "concept": "301aee32-885f-4f56-aed1-497ad7aaf8d7" } }, { "label": "Relationship", "type": "obs", "required": false, "id": "relationship", "questionOptions": { "rendering": "radio", "concept": "f5d1f4ec-22b8-4b47-a136-1ffb12aefe31", "answers": [ { "concept": "163565AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Casual sexual partner" }, { "concept": "1528AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Child" }, { "concept": "10540efa-421e-4a6d-b2a3-22cb4ceee6d0", "label": "Non-Spouse Partner" }, { "concept": "1527AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Parent" }, { "concept": "5617AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Partner or spouse" }, { "concept": "972AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Sibling" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] }, "validators": [] }, { "label": "Address", "type": "obs", "required": false, "id": "address", "questionOptions": { "rendering": "text", "concept": "1eb080aa-7921-425e-801f-b53f4ca93a7d" } }, { "label": "Home Phone Number", "type": "obs", "required": false, "id": "homePhoneNumber", "questionOptions": { "rendering": "text", "concept": "2481f720-0490-4c89-aeb8-dd128b8cb001" } }, { "label": "Mobile Phone Number", "type": "obs", "required": false, "id": "mobilePhoneNumber", "questionOptions": { "rendering": "text", "concept": "d266ec50-0ba1-442a-8f2c-7895eaad84ab" } }, { "label": "Work Phone Number", "type": "obs", "required": false, "id": "workPhoneNumber", "questionOptions": { "rendering": "text", "concept": "605a3cfe-a072-4b1b-8067-317538ffdfbb" } } ] }, { "label": "Case Information", "isExpanded": "true", "questions": [ { "label": "Currently living with the Index Case", "type": "obs", "required": false, "id": "currentlyLivingWithIndexCase", "questionOptions": { "rendering": "radio", "concept": "fad2e4c5-d6f3-47b4-bb94-eb5f3539775b", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "validators": [] }, { "label": "Health status of the client", "type": "obs", "questionOptions": { "rendering": "radio", "concept": "4ab0e5e3-fff7-4819-bd2e-4f070eedcd3d", "answers": [ { "concept": "1855AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Healthy", "conceptMappings": [] }, { "concept": "9c849633-3589-42c7-bcb1-b4af7ec392c5", "label": "Chronically Ill", "conceptMappings": [] }, { "concept": "160432AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Dead", "conceptMappings": [] } ] }, "id": "healthStatusOfClient" }, { "label": "Has the client been previously tested", "type": "obs", "required": false, "id": "hasTheClientBeenPreviouslyTested", "questionOptions": { "rendering": "radio", "concept": "f4bcd7bc-83c2-40b1-9159-dadb97a83fc8", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "validators": [] }, { "label": "Previous Date Tested", "type": "obs", "required": false, "id": "previousDateTested", "questionOptions": { "rendering": "date", "concept": "87a98d42-ec07-46a0-b291-36f66b68fe2c" } }, { "label": "Previous HIV Test Result", "type": "obs", "required": false, "id": "previousTestResult", "questionOptions": { "rendering": "select", "concept": "23ef2580-e9e5-4e1b-af9b-584cdd30abc4", "answers": [ { "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Positive" }, { "concept": "5e4fc757-0b14-49ae-b3b7-419666f41e15", "label": "Negative" }, { "concept": "1067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Unknown" } ] } }, { "label": "Is the contact counseled for HIV today", "type": "obs", "required": false, "id": "isTheCotanctCounseledForHiv", "questionOptions": { "rendering": "radio", "concept": "0692893e-95bd-4749-a7fe-b0ca96a79407", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Has the contact been tested for HIV", "type": "obs", "required": false, "id": "hasTheContactBeenTestedForHIV", "questionOptions": { "rendering": "radio", "concept": "fa1d653a-c84e-48ad-9daa-447c4d87c497", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Date Tested", "type": "obs", "required": false, "id": "dateTested", "questionOptions": { "rendering": "date", "concept": "05124366-dd0d-4bf1-91ac-5d6c2f76ad55" } }, { "label": "HIV Test Result", "type": "obs", "required": false, "id": "hivTestResult", "questionOptions": { "rendering": "select", "concept": "fee36db1-6b65-4625-b1ac-6290716f39b7", "answers": [ { "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Positive" }, { "concept": "664AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Negative" }, { "concept": "165649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Unknown" } ] } }, { "label": "Linked to HIV Care", "type": "obs", "required": false, "id": "linkedToHivCare", "questionOptions": { "rendering": "radio", "concept": "c1bb9738-10aa-4905-bb5d-af4e55b4bb69", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Contact MRN", "type": "obs", "required": false, "id": "contactMRN", "questionOptions": { "rendering": "text", "concept": "9f760fe1-5cde-41ab-99b8-b8e1d77de902" } }, { "label": "Contact UAN", "type": "obs", "required": false, "id": "contactUAN", "questionOptions": { "rendering": "text", "concept": "72750cad-0b54-4875-97c7-c94fb9caa50e" } }, { "label": "Reason for not testing", "type": "obs", "required": false, "id": "reasonForNotTesting", "questionOptions": { "rendering": "radio", "concept": "c51e4c11-369c-4b12-a55c-11580f04a7ac", "answers": [ { "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Known HIV Positive" }, { "concept": "afe90395-0720-4515-929b-6796e45a11ae", "label": "Refused" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Has the partner started ART", "type": "obs", "required": false, "id": "hasThePartnerStartedART", "questionOptions": { "rendering": "radio", "concept": "b285191d-56ff-4244-83a6-38c3fa2a33f7", "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Partner UAN", "type": "obs", "required": false, "id": "partnerUAN", "questionOptions": { "rendering": "text", "concept": "668bdf1d-2da0-4c6c-83b1-f5ab3fa9bdae" } } ] } ] } ], "availableIntents": [ { "intent": "*", "display": "default_intent" } ], "processor": "EncounterFormProcessor", "encounterType": "57c02902-a9fe-4b63-a1a7-0a070fd3a48a", "referencedForms": [], "uuid": "1283d7d6-6431-446d-87d1-6fe00177cb85", "description": "Family Index Case Contacts" }