@icap-ethiopia/esm-ethiohri-app

{ "name": "POC Index Contact Followup", "version": "1.0", "published": true, "retired": false, "encounter": "Index Contact Followup", "processor": "EncounterFormProcessor", "referencedForms": [], "uuid": "8a75cc8f-d700-4b09-8ict-contact28d89", "encounterType": "8a75cc8f-d700-4b09-8b96-97d519728d89", "allowUnspecifiedAll": true, "pages": [ { "label": "POC ICT FOLLOWUP", "sections": [ { "label": "CONTACT'S INFORMATION", "isExpanded": "true", "questions": [ { "label": "Elicited date", "type": "obs", "required": false, "id": "elicitedDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "58abd286-8f57-4717-aa41-efd8e93d5902", "conceptMappings": [], "answers": [] } }, { "label": "Contact's First Name", "type": "obs", "required": false, "id": "contactFirstName", "validators": [ { "type": "js_expression", "failsWhenExpression": "myValue.length > 20", "message": "Please use a maximum of 20 characters" } ], "questionOptions": { "rendering": "text", "concept": "166102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "conceptMappings": [ { "relationship": "SAME-AS", "type": "PIH", "value": "2725" }, { "relationship": "SAME-AS", "type": "CIEL", "value": "166102" }, { "relationship": "SAME-AS", "type": "SNOMED-CT", "value": "408677003" } ], "answers": [] } }, { "label": "Contact's Middle Name", "type": "obs", "required": false, "id": "contactMiddleName", "questionOptions": { "rendering": "text", "concept": "166574AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "conceptMappings": [ { "relationship": "SAME-AS", "type": "SNOMED-CT", "value": "716057004" }, { "relationship": "SAME-AS", "type": "CIEL", "value": "166574" } ], "answers": [] }, "validators": [ { "type": "js_expression", "failsWhenExpression": "myValue.length > 20", "message": "Please use a maximum of 20 characters" } ] }, { "label": "Contact's Grand Father Name", "type": "obs", "required": false, "id": "contactLastName", "questionOptions": { "rendering": "text", "concept": "166103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "conceptMappings": [ { "relationship": "SAME-AS", "type": "PIH", "value": "2724" }, { "relationship": "SAME-AS", "type": "SNOMED-CT", "value": "397678008" }, { "relationship": "SAME-AS", "type": "CIEL", "value": "166103" } ], "answers": [] }, "validators": [ { "type": "js_expression", "failsWhenExpression": "myValue.length > 20", "message": "Please use a maximum of 20 characters" } ] }, { "label": "Phone #/Physical Address", "type": "obs", "required": false, "id": "contactPhoneNumber", "questionOptions": { "rendering": "text", "concept": "159635AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "conceptMappings": [ { "relationship": "SAME-AS", "type": "CIEL", "value": "159635" }, { "relationship": "SAME-AS", "type": "SNOMED-CT", "value": "184103008" }, { "relationship": "SAME-AS", "type": "org.openmrs.module.mdrtb", "value": "TELEPHONE NUMBER" } ], "answers": [] } }, { "label": "Age", "type": "obs", "required": false, "id": "contactAge", "questionOptions": { "rendering": "number", "calculate": { "calculateExpression": "getAgeFromBirthdate('dateOfBirth')" }, "concept": "1532AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "max": 200, "min": 0, "showDate": "", "conceptMappings": [ { "type": "CIEL", "value": "1532" } ] } }, { "label": "Date of Birth", "type": "obs", "required": false, "id": "dateOfBirth", "questionOptions": { "rendering": "date", "calculate": { "calculateExpression": "getBirthdateFromAge('contactAge')" }, "concept": "e27ae70c-6131-4004-9da8-841619e19480" } }, { "label": "Sex", "type": "obs", "required": false, "id": "contactGender", "questionOptions": { "rendering": "radio", "concept": "1533AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "conceptMappings": [ { "relationship": "SAME-AS", "type": "LOINC", "value": "72143-4" }, { "relationship": "SAME-AS", "type": "CIEL", "value": "1533" } ], "answers": [ { "concept": "1535AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Female" }, { "concept": "1534AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Male" } ] }, "validators": [] }, { "label": "Contact category", "type": "obs", "required": false, "id": "contactCategory", "questionOptions": { "rendering": "radio", "concept": "a7d17e7a-a8b2-49b5-84f1-aade1277b658", "conceptMappings": [], "answers": [ { "concept": "a79a78a5-e983-4a1d-986c-6868a04da28e", "label": "Sex Partner" }, { "concept": "5c306c62-1141-47c5-8754-b5dfbd0bbe48", "label": "Child (< 19)" }, { "concept": "1527AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Parent" }, { "concept": "972AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Sibling (< 19)" }, { "concept": "5617AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Spouse" }, { "concept": "10540efa-421e-4a6d-b2a3-22cb4ceee6d0", "label": "Non-spouse partner" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Specify other category", "type": "obs", "questionOptions": { "rendering": "text", "concept": "316017c2-7e8b-4607-ab86-889484f79edb" }, "hide": { "hideWhenExpression": "contactCategory !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "otherCategory" }, { "label": "IPV risk assessed", "type": "obs", "required": false, "id": "ipvRisk", "questionOptions": { "rendering": "radio", "concept": "bf64b919-2e57-4f96-82c8-7d551b506181", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" }, { "concept": "1175AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Not applicable" } ] } }, { "label": "IPV risk assessment outcome", "type": "obs", "required": false, "hide": { "hideWhenExpression": "ipvRisk !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "ipvRiskOutcome", "questionOptions": { "rendering": "checkbox", "concept": "d9843fda-3799-4727-8695-02292f4a90b4", "conceptMappings": [], "answers": [ { "concept": "152292AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Physical" }, { "concept": "118668AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Emotional" }, { "concept": "152370AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Sexual" }, { "concept": "fe881e9b-fafe-4f06-936b-22cd20165044", "label": "No IPV" }, { "concept": "61712cf4-7898-4b38-a202-6d68a83dbf01", "label": "NA child" } ] } }, { "label": "Linked to PGBV care", "type": "obs", "required": false, "id": "linkedToPgbv", "questionOptions": { "rendering": "radio", "concept": "5fdc49a5-18fd-4817-8270-9e5b4f47c62f", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "HIV status disclosed by index client?", "type": "obs", "required": false, "id": "hivStatusDisclosed", "questionOptions": { "rendering": "radio", "concept": "e62278d3-1f46-48b3-9f34-bd2543a35275", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } } ] }, { "label": "NOTIFICATION PLAN", "isExpanded": "true", "questions": [ { "label": "Notification plan", "type": "obs", "required": false, "id": "notificationPlan", "questionOptions": { "rendering": "select", "concept": "4d789ec1-9ea9-4b5e-bc27-a0611c4f8310", "conceptMappings": [], "answers": [ { "concept": "9e67687f-5df5-43c1-acd0-134295791541", "label": "No Notification (IPV+)" }, { "concept": "013a416d-b517-415d-aba2-e7dbae5014b1", "label": "Client" }, { "concept": "19785c69-e16c-412a-af3f-5a77979c99ff", "label": "Contractual" }, { "concept": "d53de30f-62a5-454a-a5f9-215b803b2122", "label": "Dual" }, { "concept": "f7dcfbd8-d3fb-4a95-a321-fa6d8e9a7212", "label": "Provider" } ] } }, { "label": "Notified face-to-face", "type": "obs", "required": false, "id": "notifiedFaceToFace", "questionOptions": { "rendering": "radio", "concept": "44c1b588-46e4-47c5-85f8-7bebca1579d2", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Trial date 1st", "type": "obs", "required": false, "id": "trialDate1", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "36fdf1b1-bb8e-4f6f-9a3c-dd1f224187c7", "conceptMappings": [], "answers": [] } }, { "label": "Trial outcome 1st", "type": "obs", "required": false, "id": "trialOutcome1", "questionOptions": { "rendering": "text", "concept": "735d0478-411a-430c-9cb4-1fe8b9c9dc3d", "conceptMappings": [], "answers": [] } }, { "label": "Trial date 2nd", "type": "obs", "required": false, "id": "trialDate2", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "9160fae7-0a61-4be9-b38a-97db3c621c66", "conceptMappings": [], "answers": [] } }, { "label": "Trial outcome 2nd", "type": "obs", "required": false, "id": "trialOutcome2", "questionOptions": { "rendering": "text", "concept": "360ced7c-774e-440f-abe4-3100d3e30d1b", "conceptMappings": [], "answers": [] } }, { "label": "Trial date 3rd", "type": "obs", "required": false, "id": "trialDate3", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "7ac249fc-4520-4581-a33c-7d5020a7f57b", "conceptMappings": [], "answers": [] } }, { "label": "Trial outcome 3rd", "type": "obs", "required": false, "id": "trialOutcome3", "questionOptions": { "rendering": "text", "concept": "da238ed9-14dc-4299-9752-7141fbe3cf43", "conceptMappings": [], "answers": [] } } ] }, { "label": "PRIOR TEST", "isExpanded": "true", "questions": [ { "label": "Prior HIV test result", "type": "obs", "required": false, "id": "priorHivTestResult", "questionOptions": { "rendering": "radio", "concept": "0f4be70c-f1dc-434b-acba-fc1421854bc4", "conceptMappings": [], "answers": [ { "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Positive" }, { "concept": "5e4fc757-0b14-49ae-b3b7-419666f41e15", "label": "Negative" } ] } }, { "label": "Estimated test date", "type": "obs", "required": false, "id": "estimatedTestDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "67e5e461-c1bd-44fc-8b74-5929a388df9a", "conceptMappings": [], "answers": [] } }, { "label": "Duration since last test (in months)", "type": "obs", "required": false, "id": "durationSince", "questionOptions": { "rendering": "text", "concept": "d002eb43-bcba-4435-8e0d-b0a6130f09bd", "conceptMappings": [], "answers": [] } } ] }, { "label": "HIVST", "isExpanded": "true", "questions": [ { "label": "Date HIVST kit distributed", "type": "obs", "required": false, "id": "hivstKitDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "947073ef-aa76-42cb-a361-1641149a8100", "conceptMappings": [], "answers": [] } }, { "label": "HIVST report date", "type": "obs", "required": false, "id": "hivstReportDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "70e43194-c463-444d-a631-db938fbc1bdc", "conceptMappings": [], "answers": [] } }, { "label": "HIVST result", "type": "obs", "required": false, "id": "hivstResult", "questionOptions": { "rendering": "radio", "concept": "e77fb81b-7811-41e4-8f30-af101d9c1c6b", "conceptMappings": [], "answers": [ { "concept": "165090AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Recent" }, { "concept": "c74f4c43-c85a-43f0-87a2-2554178ab714", "label": "NR" } ] } } ] }, { "label": "NATIONAL ALGORITHM", "isExpanded": "true", "questions": [ { "label": "HIV test date", "type": "obs", "questionOptions": { "rendering": "date", "concept": "164400AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "weeksList": "", "conceptMappings": [ { "type": "CIEL", "value": "164400" } ] }, "validators": [ { "type": "date", "allowFutureDates": "false" } ], "id": "hivTestDate" }, { "label": "HIV test result", "type": "obs", "required": false, "id": "hivTestResult", "questionOptions": { "rendering": "select", "concept": "2e770be1-7397-4684-bea6-6632c23b00d7", "conceptMappings": [], "answers": [ { "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Positive" }, { "concept": "5e4fc757-0b14-49ae-b3b7-419666f41e15", "label": "Negative" }, { "concept": "165649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Inconclusive" } ] }, "validators": [] }, { "label": "Tested at", "type": "obs", "required": false, "id": "testedAt", "questionOptions": { "rendering": "radio", "concept": "9e998da3-eb3d-49c2-9650-fb1102a2da09", "conceptMappings": [], "answers": [ { "concept": "1537AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Health facility" }, { "concept": "163488AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Community" } ] } } ] }, { "label": "RTRI", "isExpanded": "true", "questions": [ { "label": "Eligible for Recency testing", "type": "obs", "required": false, "id": "eligibleForRecency", "questionOptions": { "rendering": "radio", "concept": "63ffc936-492f-4ee3-b24e-d6d8a72674a9", "conceptMappings": [], "answers": [ { "concept": "8875cb57-a667-474d-9f9b-d3e592dfc75b", "label": "E" }, { "concept": "b64e1eea-9dc4-4149-8644-646980d2ab4b", "label": "NE" } ] } }, { "label": "Tested for Recency?", "type": "obs", "required": false, "id": "testedForRecency", "questionOptions": { "rendering": "radio", "concept": "ac70a921-72dd-47a4-a944-b1119240332e", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "RTRI Result", "type": "obs", "required": false, "hide": { "hideWhenExpression": "testedForRecency !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "id": "rtriResult", "questionOptions": { "rendering": "radio", "concept": "3e0c5f07-cea4-4da5-8091-854c4d343bc0", "conceptMappings": [], "answers": [ { "concept": "165090AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "R" }, { "concept": "c0b85e2c-8c7e-456e-a0d5-1280c8bfa7d4", "label": "LT" }, { "concept": "07896600-8646-4f15-9a5b-92593ee5008f", "label": "IR" } ] } } ] }, { "label": "CARE & TREATMENT", "isExpanded": "true", "questions": [ { "label": "Date linked to care", "type": "obs", "required": false, "id": "linkedToCareDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "d7e22235-9820-48d9-af05-bc2a906f7b46", "conceptMappings": [], "answers": [] } }, { "label": "Date ART started", "type": "obs", "questionOptions": { "rendering": "date", "concept": "ae329187-6232-4142-aa91-22c85bc8e5b5", "weeksList": "" }, "validators": [ { "type": "date", "allowFutureDates": "false" } ], "id": "artStartDate" }, { "label": "UAN of newly identified HIV +ve", "type": "obs", "required": false, "id": "contactUan", "questionOptions": { "rendering": "text", "concept": "72750cad-0b54-4875-97c7-c94fb9caa50e", "conceptMappings": [], "answers": [] } } ] }, { "label": "ICT FOR HIV +VE CONTACT", "isExpanded": "true", "questions": [ { "label": "Date linked to ICT service", "type": "obs", "required": false, "id": "dateLinkedToIct", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "8307d4cb-120f-4b8e-a51c-52bd4ab9f768", "conceptMappings": [], "answers": [] } }, { "label": "Reason if not linked to ICT", "type": "obs", "required": false, "id": "reasonNotLinkedIct", "questionOptions": { "rendering": "radio", "concept": "fc1ed555-346f-4757-8c9d-f05895955538", "conceptMappings": [], "answers": [ { "concept": "5b0bd7f0-6792-4e9b-b250-7589ffc4db0b", "label": "Referred" }, { "concept": "afe90395-0720-4515-929b-6796e45a11ae", "label": "Declined" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } } ] }, { "label": "PREP FOR HIV -VE PARTNER", "isExpanded": "true", "questions": [ { "label": "Screened for PrEP", "type": "obs", "required": false, "id": "screenedForPrep", "questionOptions": { "rendering": "radio", "concept": "8c6a4530-78f6-41fe-ba85-29429257bea0", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "validators": [] }, { "label": "Eligible for PrEP", "type": "obs", "required": false, "id": "eligibileForPrep", "questionOptions": { "rendering": "radio", "concept": "e5d11e73-835a-4fdf-9924-ed59c6a18f3d", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "validators": [] }, { "label": "Started Oral PrEP", "type": "obs", "required": false, "id": "prepStarted", "questionOptions": { "rendering": "radio", "concept": "3b4bc0b2-acbb-4fb5-82eb-6f0479915862", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] }, "validators": [] }, { "label": "PrEP start date", "type": "obs", "required": false, "id": "prepStartDate", "hide": { "hideWhenExpression": "prepStarted !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" }, "questionOptions": { "rendering": "date", "concept": "163526AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "conceptMappings": [ { "relationship": "SAME-AS", "type": "SNOMED-CT", "value": "413946009" }, { "relationship": "SAME-AS", "type": "CIEL", "value": "163526" }, { "relationship": "SAME-AS", "type": "SNOMED-CT", "value": "413946009" }, { "relationship": "SAME-AS", "type": "CIEL", "value": "163526" } ], "answers": [] } } ] }, { "label": "SCREENED FOR AE", "isExpanded": "true", "questions": [ { "label": "AE type 1st report", "type": "obs", "required": false, "id": "aeReport1", "questionOptions": { "rendering": "text", "concept": "d2bd964c-68b9-4d7f-99c4-df0573cf24c6", "conceptMappings": [], "answers": [] } }, { "label": "AE for IPV report date 1st", "type": "obs", "required": false, "id": "aeDate1", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "530884fa-592f-475a-92ad-68407e09faff", "conceptMappings": [], "answers": [] } }, { "label": "AE type 2nd report", "type": "obs", "required": false, "id": "aeReport2", "questionOptions": { "rendering": "text", "concept": "86760598-b311-42f1-950d-2c15ee2c5d93", "conceptMappings": [], "answers": [] } }, { "label": "AE for IPV report date 2nd", "type": "obs", "required": false, "id": "aeDate2", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "d3861816-a406-4291-a105-f97800250710", "conceptMappings": [], "answers": [] } }, { "label": "AE type 3rd report", "type": "obs", "required": false, "id": "aeReport3", "questionOptions": { "rendering": "text", "concept": "6218ab27-803f-4d2b-95ed-44725aaae77e", "conceptMappings": [], "answers": [] } }, { "label": "AE for IPV report date 3rd",