@icap-ethiopia/esm-ethiohri-app
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A microfrontend ethiohri OpenMRS
1,096 lines (1,028 loc) • 29.1 kB
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{
"name": "POC Intake-A",
"version": "1.0",
"published": true,
"retired": false,
"encounter": "Intake A",
"pages": [
{
"label": "HIV CARE/ART CLINIC INTAKE FORM-A",
"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"
}
},
"id": "enrollment_date"
},
{
"label": "Unit TB No.",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "cce18aff-7923-454f-97fd-2048c75c710a"
},
"id": "unit_tb_no"
},
{
"label": "Target Population Category",
"type": "obs",
"required": false,
"id": "targetPopulation",
"questionOptions": {
"rendering": "select",
"concept": "ca2c04ba-d9bd-4bad-ab03-e57ea9e49016",
"answers": [
{
"concept": "166513AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Female Commercial Sex workers"
},
{
"concept": "162198AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Distance Drivers"
},
{
"concept": "9fb6c25b-4765-463b-9f26-7cc3addf1105",
"label": "Mobile or Daily Laborers"
},
{
"concept": "e53cf0d0-86ed-4b20-aa93-58546b970c63",
"label": "Prisoners"
},
{
"concept": "b696f324-05a5-49ba-8577-6172195473fc",
"label": "OVC or AIDS Orphaned"
},
{
"concept": "e916113e-8d95-43f5-a07c-a21a8aca9bed",
"label": "Children of PLHIV"
},
{
"concept": "360d3b35-4946-454c-86e6-815fed0723f2",
"label": "Partner of PLHIV"
},
{
"concept": "bbe26d24-f535-4a27-8453-ca45d373c827",
"label": "Discordant Couples"
},
{
"concept": "518b0c9b-5361-45c0-b9a6-79833b9981bf",
"label": "TG"
},
{
"concept": "160578AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Male who has sex with men"
},
{
"concept": "f99862c6-ebc6-480a-903c-ca28f41e2518",
"label": "People who inject drug"
},
{
"concept": "164100AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Refugee"
},
{
"concept": "2453316b-2e88-43d7-87c9-32ef4725ec5d",
"label": "Other MARPS-Wido-Divo-Sepa"
},
{
"concept": "166430AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "General population"
}
]
},
"validators": []
},
{
"label": "Client (Child's care giver) marital status",
"type": "obs",
"required": false,
"id": "childsCareGiverMaritalStatus",
"questionOptions": {
"rendering": "select",
"concept": "e6eb59a1-8430-491d-b948-5b582f87d5ea",
"answers": [
{
"concept": "1057AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Never married"
},
{
"concept": "5555AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Married"
},
{
"concept": "1058AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Divorced"
},
{
"concept": "1059AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Widowed"
},
{
"concept": "1056AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Separated"
},
{
"concept": "1060AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Living with partner"
}
]
},
"validators": []
},
{
"label": "Religion",
"type": "obs",
"required": false,
"id": "religion",
"questionOptions": {
"rendering": "select",
"concept": "22612cd9-5ec5-4196-b7cc-80ba37e8a13f",
"answers": [
{
"concept": "12f7b48b-38c4-4377-82a3-215b9da86752",
"label": "Orthodox"
},
{
"concept": "2a03b89e-51d1-4d80-90d8-af085c3a481d",
"label": "Muslim"
},
{
"concept": "3b344266-b983-4906-b768-312fadd5f5d6",
"label": "Catholic"
},
{
"concept": "d66c7928-b124-437b-818d-1b3d99116200",
"label": "Protestant"
},
{
"concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
},
"validators": []
},
{
"label": "Specify other religion",
"type": "obs",
"required": false,
"hide": {
"hideWhenExpression": "religion != '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"id": "otherReligion",
"questionOptions": {
"rendering": "text",
"concept": "5285ef6e-3e4c-446d-a0fa-51ce5ea7865c",
"answers": []
},
"validators": []
},
{
"label": "Level of Education",
"type": "obs",
"required": false,
"id": "levelOfEducation",
"questionOptions": {
"rendering": "select",
"concept": "0022deac-d7a0-471a-bbdc-e41fc0e92bb4",
"answers": [
{
"concept": "160294AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "No Education"
},
{
"concept": "1713AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Primary"
},
{
"concept": "1714AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Secondary"
},
{
"concept": "160292AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Tertiary"
},
{
"concept": "9f978371-0866-4685-908f-bcbf2b128725",
"label": "TVET"
},
{
"concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
},
"validators": []
},
{
"label": "Specify other level of education",
"type": "obs",
"required": false,
"hide": {
"hideWhenExpression": "levelOfEducation != '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"id": "otherEducation",
"questionOptions": {
"rendering": "text",
"concept": "319efe14-16fc-49f9-907f-e8e45501971d",
"answers": []
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 50",
"message": "Please use a maximum of 50 characters"
}
]
},
{
"label": "Occupation",
"type": "obs",
"required": false,
"id": "occupation",
"questionOptions": {
"rendering": "text",
"concept": "2d2073e1-8377-4c4a-b6c7-0ab848760716",
"answers": []
},
"validators": []
},
{
"label": "Residential Type",
"type": "obs",
"required": false,
"id": "residentialType",
"questionOptions": {
"rendering": "radio",
"concept": "6f612018-bc64-4ab2-86f8-efde342b07d0",
"answers": [
{
"concept": "515f3768-30f6-4b87-bc9c-c64ce42db187",
"label": "Rural"
},
{
"concept": "32e92a9c-cc61-4079-851a-afc56808037a",
"label": "Urban"
}
]
},
"validators": []
},
{
"label": "Client reside within the catchments area?",
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "6c309c37-5ecb-4506-a4e6-201d4c90e6a3",
"answers": [
{
"concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Yes"
},
{
"concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "No"
}
]
},
"id": "catchment_area"
},
{
"label": "Is challenge anticipated to regularly follow in this facility?",
"type": "obs",
"required": false,
"id": "regular_followup",
"hide": {
"hideWhenExpression": "catchment_area != '1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"questionOptions": {
"rendering": "radio",
"concept": "f93c0a7d-9578-4fb2-afd1-6a7f477a7e1a",
"answers": [
{
"concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Yes"
},
{
"concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "No"
}
]
},
"validators": []
}
]
},
{
"label": "FOR CHILD <5 YEARS ONLY",
"isExpanded": "true",
"hide": {
"hideWhenExpression": "age > 4"
},
"questions": [
{
"label": "Mother's First Name",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "1593AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 20",
"message": "Please use a maximum of 20 characters"
}
],
"id": "mothers_name"
},
{
"label": "Mother's Father's Name",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "1594AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 20",
"message": "Please use a maximum of 20 characters"
}
],
"id": "mothers_father_name"
},
{
"label": "Mother's Grand Father's Name",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "1b545ea1-0aed-4632-af99-ea2ceb61b13c"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 20",
"message": "Please use a maximum of 20 characters"
}
],
"id": "mothers_grandfather_name"
},
{
"label": "Place of delivery",
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "1572AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"answers": [
{
"concept": "1588AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Health Facility"
},
{
"concept": "1536AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Home"
},
{
"concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
},
"id": "placeOfDelivery"
},
{
"label": "Other place of delivery",
"type": "obs",
"required": false,
"id": "otherPlaceOfDelivery",
"questionOptions": {
"rendering": "text",
"concept": "2f3c7d4f-198f-40ce-94d2-a968c8c4bea4",
"answers": []
},
"hide": {
"hideWhenExpression": "placeOfDelivery !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 50",
"message": "Please use a maximum of 50 characters"
}
]
},
{
"label": "Mode of delivery",
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "5630AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"answers": [
{
"concept": "1170AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Spontaneous Vaginal"
},
{
"concept": "1171AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Cesarean Section"
},
{
"concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
},
"id": "modeOfDelivery"
},
{
"label": "Other mode of delivery",
"type": "obs",
"required": false,
"id": "otherModeOfDelivery",
"questionOptions": {
"rendering": "text",
"concept": "ed73985e-cbab-4912-8275-0c037d5674a3",
"answers": []
},
"hide": {
"hideWhenExpression": "modeOfDelivery !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 50",
"message": "Please use a maximum of 50 characters"
}
]
}
]
},
{
"label": "HIV TEST INFORMATION",
"isExpanded": "true",
"questions": [
{
"label": "Date confirmed HIV+ / Retesting",
"type": "obs",
"required": true,
"questionOptions": {
"rendering": "date",
"concept": "160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"validators": [
{
"type": "date",
"allowFutureDates": "false"
},
{
"type": "js_expression",
"failsWhenExpression": "myValue > enrollment_date",
"message": "HIV confirmation date should be earlier than enrollment date"
},
{
"type": "js_expression",
"failsWhenExpression": "myValue < new Date(patient.birthDate)",
"message": "HIV confirmation date should not be earlier than Birth date"
}
],
"id": "date_confirmed"
},
{
"label": "Type of HIV test",
"type": "obs",
"required": false,
"id": "test_type",
"questionOptions": {
"rendering": "radio",
"concept": "5583b0a6-f390-446d-ab39-d98584ee330c",
"answers": [
{
"concept": "163722AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Rapid HIV test"
},
{
"concept": "164461AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "DBS/PCR (for children)"
}
]
},
"validators": []
}
]
},
{
"label": "CLIENT REFERRAL INFORMATION",
"isExpanded": "true",
"questions": [
{
"label": "Entry point",
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "dd282c99-ea69-44e7-9252-aff0198cc1e8",
"answers": [
{
"concept": "163266AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "From Within the Health Facility"
},
{
"concept": "164407AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Outside the facility"
}
]
},
"id": "entryPoint"
},
{
"label": "From Within the Health Facility",
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "d2b461e5-dd7f-4d16-968e-354ac68cbd38",
"answers": [
{
"concept": "160448AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Medical outpatient"
},
{
"concept": "160457AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Pediatric outpatient"
},
{
"concept": "af37cab4-73ad-49ff-b9d7-2a89d54d7118",
"label": "TB Clinic"
},
{
"concept": "14497d04-ec43-4ac4-9cab-02007a0ff273",
"label": "PNC"
},
{
"concept": "d1e97037-c599-47c3-93cb-c256b9c27fbc",
"label": "L&D"
},
{
"concept": "160538AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "MCH (PMTCT)"
},
{
"concept": "2959b6f7-1f9b-49cd-9f3a-1e42e87b4ae5",
"label": "ANC"
},
{
"concept": "160546AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "STI clinic"
},
{
"concept": "159940AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "VCT"
},
{
"concept": "5485AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Adult IPD"
},
{
"concept": "f6b54649-54ab-451d-b66f-94bf2887d922",
"label": "Pediatric IPD"
},
{
"concept": "e7e85a1a-1e45-4043-99d7-216034965bc5",
"label": "Other OPD"
},
{
"concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
},
"hide": {
"hideWhenExpression": "entryPoint !== '163266AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"id": "within_the_facility"
},
{
"label": "Other entry point within the facility",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "a0368d36-686d-4b98-b60e-e62cb3d46c9b"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 50",
"message": "Please use a maximum of 50 characters"
}
],
"hide": {
"hideWhenExpression": "within_the_facility !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"id": "otherEntryPointWithinTheFacility"
},
{
"label": "Outside the Health Facility",
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "73d76014-365e-484c-bf5b-0959add4e3f3",
"answers": [
{
"concept": "1275AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Health Center"
},
{
"concept": "160480AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Public Hospital"
},
{
"concept": "1589AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Private Hospital"
},
{
"concept": "163014AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "NGO/FBO Hospital"
},
{
"concept": "160479AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Private Clinic"
},
{
"concept": "b70be5c7-4388-4e12-9b0e-53f01ae2a3f5",
"label": "Self referred"
},
{
"concept": "163488AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Community referred"
},
{
"concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
},
"hide": {
"hideWhenExpression": "entryPoint !== '164407AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"id": "outside_the_facility"
},
{
"label": "Other entry point outside the facility",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "2c30c599-1e4f-46f9-8488-5ab57cdc8ac3"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 50",
"message": "Please use a maximum of 50 characters"
}
],
"hide": {
"hideWhenExpression": "entryPoint !== '164407AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA' || !includes('outside_the_facility','5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA')"
},
"id": "otherEntryPointOutsideTheFacility"
},
{
"label": "Reason for referral",
"type": "obs",
"id": "reason_for_referral",
"readonly": "true",
"questionOptions": {
"rendering": "radio",
"concept": "5f34e705-3574-4b44-b455-d815962026a1",
"answers": [
{
"concept": "159811AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "To be enrolled as transferred in ART client"
},
{
"concept": "164144AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "To be enrolled as new Pre-ART client"
},
{
"concept": "cc2dfcbd-e099-47d5-b01c-74caa296ba3c",
"label": "To be enrolled as transferred in Pre-ART client"
}
]
}
}
]
},
{
"label": "CARE GIVER/EMERGENCY CONTACT INFORMATION",
"isExpanded": "true",
"questions": [
{
"label": "First Name",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "166102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"id": "care_giver_first_name"
},
{
"label": "Father's Name",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "166574AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"id": "care_giver_fathers_name"
},
{
"label": "Grand Father's Name",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "166103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"id": "care_giver_grandfathers_name"
},
{
"label": "Age",
"type": "obs",
"questionOptions": {
"rendering": "number",
"concept": "1532AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"max": 200,
"min": 0,
"showDate": "false"
},
"id": "careGiverAge"
},
{
"label": "Sex",
"type": "obs",
"required": false,
"id": "careGiverGender",
"questionOptions": {
"rendering": "radio",
"concept": "1533AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"conceptMappings": [
{
"relationship": "SAME-AS",
"type": "LOINC",
"value": "72143-4"
},
{
"relationship": "SAME-AS",
"type": "CIEL",
"value": "1533"
}
],
"answers": [
{
"concept": "1534AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Male"
},
{
"concept": "1535AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Female"
}
]
}
},
{
"label": "Address",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "1eb080aa-7921-425e-801f-b53f4ca93a7d"
},
"id": "addressRegion"
},
{
"label": "Phone Number",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "d266ec50-0ba1-442a-8f2c-7895eaad84ab"
},
"id": "telephoneMobile"
},
{
"label": "Relationship",
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "1560AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"answers": [
{
"concept": "5617AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Spouse"
},
{
"concept": "971AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Father"
},
{
"concept": "970AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Mother"
},
{
"concept": "1528AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Child"
},
{
"concept": "160729AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Brother"
},
{
"concept": "160730AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Sister"
},
{
"concept": "974AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Extended family member"
},
{
"concept": "972AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Friend/Colleague"
},
{
"concept": "5620AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
},
"id": "relationship"
},
{
"label": "Other type of relationship",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "164352AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"hide": {
"hideWhenExpression": "relationship !== '5620AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"id": "otherRelationship"
}
]
},
{
"label": "DISCLOSURE AT ENROLLMENT",
"isExpanded": "true",
"questions": [
{
"label": "Does the client have family members (spouse/parent and child(ren)/siblings < 15 years old ",
"type": "obs",
"readonly": "true",
"questionOptions": {
"rendering": "radio",
"concept": "fcb687a1-f258-427a-8351-b4cd31e6ba0c",
"answers": [
{
"concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Yes"
},
{
"concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "No"
}
]
},
"id": "hasFamilyMember"
},
{
"label": "Does anyone else know about your/your child's HIV status",
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "159423AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"answers": [
{
"concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Yes"
},
{
"concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "No"
}
]
},
"id": "hivDisclosure"
},
{
"label": "Who knows your child's HIV positive status",
"type": "obs",
"required": false,
"id": "whoKnows",
"hide": {
"hideWhenExpression": "hivDisclosure !== '1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'"
},
"questionOptions": {
"rendering": "checkbox",
"concept": "de8937b6-6ebe-4302-a488-2198be481839",
"conceptMappings": [
{
"relationship": "SAME-AS",
"type": "ETHIOHRI",
"value": "whoKnowsChildsHIVPositiveStatus"
}
],
"answers": [
{
"concept": "1527AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Parent(s)"
},
{
"concept": "5617AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Spouse"
},
{
"concept": "1528AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Own child(ren)"
},
{
"concept": "5618AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Friends"
},
{
"concept": "54848ad0-6d2e-40b0-8143-57cabe3fc6e1",
"label": "Relatives"
},
{
"concept": "972AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Sibling(s)"
},
{
"concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Other"
}
]
}
},
{
"label": "Other person that knows your/your child's HIV positive status",
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "f622a8b2-55a1-4194-8579-3470609eb626"
},
"hide": {
"hideWhenExpression": "!includes('whoKnows', '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA')"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 50",
"message": "Please use a maximum of 50 characters"
}
],
"id": "otherPersonThatKnows"
}
]
},
{
"label": "NOTES",
"isExpanded": "true",
"questions": [
{
"label": "Notes",
"type": "obs",
"questionOptions": {
"rendering": "textarea",
"concept": "165095AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"rows": "8"
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "myValue.length > 250",
"message": "Please use a maximum of 250 characters"
}
],
"id": "notes"
}
]
}
]
}
],
"availableIntents": [
{
"intent": "*",
"display": "default_intent"
}
],
"processor": "EncounterFormProcessor",
"uuid": "bd51548c-6b41-4e31-b249-77780566b774",
"referencedForms": [],
"encounterType": "05add044-67f8-48c9-928d-79002ab19efe",
"allowUnspecifiedAll": true
}