@icap-ethiopia/esm-ethiohri-app

{ "name": "Partner Index Case Information", "version": "1.0", "published": true, "retired": false, "encounter": "Partner Index Case Information", "pages": [ { "label": "PARTNER INDEX CASE INFORMATION", "sections": [ { "label": "CONTACT/PARTNER INFORMATION", "isExpanded": "true", "questions": [ { "label": "Registration date", "type": "obs", "questionOptions": { "rendering": "date", "concept": "1ebc345c-6f09-43e1-a616-d7e52fff4c7d" }, "required": "false", "id": "registration_date" }, { "label": "First Name", "type": "obs", "questionOptions": { "rendering": "text", "concept": "166102AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" }, "id": "familyFirstName" }, { "label": "Father's Name", "type": "obs", "questionOptions": { "rendering": "text", "concept": "166574AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" }, "id": "familyFathersName" }, { "label": "Grand Father's Name", "type": "obs", "questionOptions": { "rendering": "text", "concept": "166103AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA" }, "id": "familyGrandfathersName" }, { "label": "Sex", "type": "obs", "required": false, "id": "familyGender", "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": "Date of birth", "type": "obs", "questionOptions": { "rendering": "date", "concept": "e27ae70c-6131-4004-9da8-841619e19480" }, "required": "false", "id": "familyDateofbirth" }, { "label": "Age", "type": "obs", "required": false, "questionOptions": { "rendering": "number", "concept": "301aee32-885f-4f56-aed1-497ad7aaf8d7", "max": 200, "min": 0, "showDate": "" }, "id": "familyAge" }, { "label": "Relationship", "type": "obs", "questionOptions": { "rendering": "select", "concept": "f5d1f4ec-22b8-4b47-a136-1ffb12aefe31", "answers": [ { "concept": "1528AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Child (Biological)" }, { "concept": "5617AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Spouse" }, { "concept": "10540efa-421e-4a6d-b2a3-22cb4ceee6d0", "label": "Non-Spouse Partner" }, { "concept": "163565AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Sexual Partner" }, { "concept": "972AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Sibling" }, { "concept": "1527AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Parent" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] }, "id": "familyRelationship" }, { "label": "Other relationship", "type": "obs", "required": false, "id": "otherRelationship", "questionOptions": { "rendering": "text", "concept": "5073143b-eb72-45aa-a4bf-4164aa858f95" }, "hide": { "hideWhenExpression": "familyRelationship !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } }, { "label": "Address", "type": "obs", "questionOptions": { "rendering": "text", "concept": "1eb080aa-7921-425e-801f-b53f4ca93a7d" }, "id": "familyAddress" }, { "label": "Home Phone Number", "type": "obs", "questionOptions": { "rendering": "text", "concept": "2481f720-0490-4c89-aeb8-dd128b8cb001" }, "id": "familyHomePhone" }, { "label": "Mobile Phone Number", "type": "obs", "questionOptions": { "rendering": "text", "concept": "d266ec50-0ba1-442a-8f2c-7895eaad84ab" }, "id": "familyMobilePhone" }, { "label": "Work Phone Number", "type": "obs", "questionOptions": { "rendering": "text", "concept": "605a3cfe-a072-4b1b-8067-317538ffdfbb" }, "id": "familyWorkPhone" }, { "label": "Followup date", "type": "obs", "required": false, "id": "followupDate", "questionOptions": { "rendering": "date", "concept": "5c118396-52dc-4cac-8860-e6d8e4a7f296", "conceptMappings": [], "answers": [] } }, { "label": "Date of last exposure", "type": "obs", "required": false, "id": "dateOfLastExposure", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "584d752a-f923-4052-b01b-32668c491cce", "conceptMappings": [], "answers": [] } }, { "label": "If exactly the date of last exposure not remembered was the exposure", "type": "obs", "questionOptions": { "rendering": "select", "concept": "5f2f843e-f53b-4c71-8920-c601b0d183ed", "answers": [ { "concept": "2bd6c7e0-4ffc-4e37-9852-9dbf97975422", "label": "In less than 3 months" }, { "concept": "9ce0fff0-efa4-42d7-b4e8-b84d975666f9", "label": "In 3 to 12 months" }, { "concept": "48bb53b2-9f76-437e-8735-cc1f801ae0fe", "label": "In greater than 12 months" } ] }, "id": "caseClosureNotRemembered" }, { "label": "Priority category", "type": "obs", "questionOptions": { "rendering": "select", "concept": "9d843a9c-686c-432e-a86a-8f011db3bf99", "answers": [ { "concept": "a6e7258a-fd42-4c7b-8d69-d2dfa1c4ce69", "label": "1" }, { "concept": "caaa3157-b4e7-44d4-8adf-a444c38ec47f", "label": "2" }, { "concept": "9314de06-6af9-4b26-800b-71bbc958fcdb", "label": "3" }, { "concept": "cad5610c-400f-46cc-87cf-39439412a923", "label": "4" } ] }, "id": "priorityCategory" }, { "label": "Intimate partner violence assessment done?", "type": "obs", "required": false, "id": "ipvAssessmentDone", "questionOptions": { "rendering": "radio", "concept": "4f273053-3a13-4463-98d2-8c927d30e327", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Has your partner ever hit, kicked, slapped, or otherwise physically hurt you", "type": "obs", "required": false, "id": "partnerHurtYou", "questionOptions": { "rendering": "radio", "concept": "a3c4ab51-117a-4d38-be9f-e1068e8e852e", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Has your partner ever threatened to hurt you?", "type": "obs", "required": false, "id": "partnerThreatened", "questionOptions": { "rendering": "radio", "concept": "f3020605-34d9-4906-8ab4-560d0b8fef10", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Has your partner ever forced you to do something sexually that made you feel uncomfortable?", "type": "obs", "required": false, "id": "partnerForcedYou", "questionOptions": { "rendering": "radio", "concept": "728c8d24-db7c-4b7b-bf2f-d07b60415a10", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Select 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 Referral" }, { "concept": "f7dcfbd8-d3fb-4a95-a321-fa6d8e9a7212", "label": "Provider Referral" }, { "concept": "d53de30f-62a5-454a-a5f9-215b803b2122", "label": "Dual Referral" }, { "concept": "19785c69-e16c-412a-af3f-5a77979c99ff", "label": "Contract Referral" } ] } }, { "label": "Is partner notified?", "type": "obs", "required": false, "id": "partnerNotified", "questionOptions": { "rendering": "radio", "concept": "39bcf22b-8023-4f77-8120-de18f49bdb08", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "If the partner not notified, reason for not notified?", "type": "obs", "required": false, "id": "reasonNotNotified", "questionOptions": { "rendering": "radio", "concept": "a60ece01-05a6-4036-9960-75a7d39ca681", "conceptMappings": [], "answers": [ { "concept": "afe90395-0720-4515-929b-6796e45a11ae", "label": "Refused" }, { "concept": "6ffde5d2-c59b-45ea-b96d-ed914e2b326f", "label": "Out of jurisdiction" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Other reason for not notified", "type": "obs", "required": false, "id": "otherReasonForNotNotified", "questionOptions": { "rendering": "text", "concept": "f4d2f07a-a901-4d70-80f3-839200e090e3" }, "hide": { "hideWhenExpression": "reasonNotNotified !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } }, { "label": "Date Notification offered", "type": "obs", "required": false, "id": "dateNotificationOffered", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "6978db94-1ae0-4056-b5f9-662c8f278228", "conceptMappings": [], "answers": [] } }, { "label": "Date Partner contacted", "type": "obs", "required": false, "id": "datePartnerContacted", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "e93a4535-bdbf-42f6-8654-69f5515822b1", "conceptMappings": [], "answers": [] } }, { "label": "If partner not contacted, reason for not contacting", "type": "obs", "required": false, "id": "reasonNotContacting", "questionOptions": { "rendering": "radio", "concept": "faa397c2-10e3-4fc1-9d1d-7c1f0b3fe3bb", "conceptMappings": [], "answers": [ { "concept": "1b767ed4-fbaf-4f3f-80d8-5b3be5c2dd7d", "label": "Unable to locate" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Other reason for not contacted", "type": "obs", "required": false, "id": "otherReasonForNotContacted", "questionOptions": { "rendering": "text", "concept": "e7ab068f-7732-4d5b-b207-8d6f767d9962" }, "hide": { "hideWhenExpression": "reasonNotContacting !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } }, { "label": "Has the partner tested for HIV?", "type": "obs", "required": false, "id": "partnerTestedHiv", "questionOptions": { "rendering": "radio", "concept": "0783b3f4-b20a-4e3e-80e1-b057361c3964", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Previous HIV test date", "type": "obs", "required": false, "id": "previousHivTestDate", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "9f209638-c93b-4a9a-8107-7ae6b548b85d", "conceptMappings": [], "answers": [] } }, { "label": "Previous test result", "type": "obs", "required": false, "id": "partnerTestedHiv", "questionOptions": { "rendering": "radio", "concept": "96fd63de-09dc-49c1-87aa-eb8c0665a072", "conceptMappings": [], "answers": [ { "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Positive" }, { "concept": "5e4fc757-0b14-49ae-b3b7-419666f41e15", "label": "Negative" }, { "concept": "165649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Inconclusive" } ] } }, { "label": "Date partner tested for HIV", "type": "obs", "required": false, "id": "partnerTestedForHiv", "validators": [ { "type": "date", "allowFutureDates": "false" } ], "questionOptions": { "rendering": "date", "concept": "05124366-dd0d-4bf1-91ac-5d6c2f76ad55", "conceptMappings": [], "answers": [] } }, { "label": "HIV tested result", "type": "obs", "required": false, "id": "hivTestedResult", "questionOptions": { "rendering": "radio", "concept": "2e770be1-7397-4684-bea6-6632c23b00d7", "conceptMappings": [], "answers": [ { "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Positive" }, { "concept": "5e4fc757-0b14-49ae-b3b7-419666f41e15", "label": "Negative" }, { "concept": "165649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Inconclusive" } ] } }, { "label": "Is the partner linked to partner service?", "type": "obs", "required": false, "id": "partnerLinkedToService", "questionOptions": { "rendering": "radio", "concept": "310ccbe6-77a9-4815-9937-774c7664b233", "conceptMappings": [], "answers": [ { "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Yes" }, { "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "No" } ] } }, { "label": "Reason why the newly diagnosed not linked to partner and family based ICT?", "type": "obs", "required": false, "id": "reasonNewlyDiagnosed", "questionOptions": { "rendering": "radio", "concept": "37a8bd53-619e-425d-8d35-907ce9cb4242", "conceptMappings": [], "answers": [ { "concept": "5b0bd7f0-6792-4e9b-b250-7589ffc4db0b", "label": "Referred" }, { "concept": "afe90395-0720-4515-929b-6796e45a11ae", "label": "Refused" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Other reason", "type": "obs", "required": false, "id": "otherReasonNotLinked", "questionOptions": { "rendering": "text", "concept": "02bcaf88-e8f0-433d-9fe2-83ad17ea5c86" }, "hide": { "hideWhenExpression": "reasonNewlyDiagnosed !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } }, { "label": "Case closure status", "type": "obs", "required": false, "id": "caseClosureStatus", "questionOptions": { "rendering": "select", "concept": "049cf42e-8d02-4030-87f9-6cf8493b8543", "conceptMappings": [], "answers": [ { "concept": "fbb90257-989b-4e14-952e-dec23acaa4ad", "label": "Successful intervention" }, { "concept": "2f1dbb1c-74c5-40e7-9be2-b389b60faccc", "label": "Intervention complete" }, { "concept": "986ef282-a52a-4503-bbd6-bcb20acfde5f", "label": "Intervention partially completed" }, { "concept": "6ffde5d2-c59b-45ea-b96d-ed914e2b326f", "label": "Out of jurisdiction" }, { "concept": "0b9ffd21-4cf4-408a-9243-4303b688221d", "label": "No sexual partner" }, { "concept": "a6e587a8-f7a0-426f-ae32-84a15aab50d3", "label": "Refused partner notification" }, { "concept": "1b767ed4-fbaf-4f3f-80d8-5b3be5c2dd7d", "label": "Unable to locate" }, { "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", "label": "Other" } ] } }, { "label": "Other status", "type": "obs", "required": false, "id": "otherCaseClosureStatus", "questionOptions": { "rendering": "text", "concept": "633a3e6e-a224-47e3-a58d-2697dcddf90b" }, "hide": { "hideWhenExpression": "caseClosureStatus !== '5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA'" } } ] } ] } ], "availableIntents": [ { "intent": "*", "display": "default_intent" } ], "processor": "EncounterFormProcessor", "uuid": "00e4d1c3-1989-4c6e-afc0-c84137fdf02d", "referencedForms": [], "encounterType": "bc17321c-a1a8-45a3-a49e-e8d0c91c476d", "allowUnspecifiedAll": true }