From d8cc15e9e110e4d732dca04299bc6953652a5550 Mon Sep 17 00:00:00 2001 From: aman-icap Date: Thu, 14 Dec 2023 09:47:58 +0300 Subject: [PATCH] Adding PMTCT followup form --- src/forms/pmtct-followup/pmtct-followup.json | 880 +++++++++++++++++++ 1 file changed, 880 insertions(+) create mode 100644 src/forms/pmtct-followup/pmtct-followup.json diff --git a/src/forms/pmtct-followup/pmtct-followup.json b/src/forms/pmtct-followup/pmtct-followup.json new file mode 100644 index 00000000..1024bdd4 --- /dev/null +++ b/src/forms/pmtct-followup/pmtct-followup.json @@ -0,0 +1,880 @@ +{ + "encounterType": "", + "name": "PMTCT Followup", + "processor": "EncounterFormProcessor", + "referencedForms": [], + "uuid": "", + "version": "1.0", + "pages": [ + { + "label": "Infant Status", + "sections": [ + { + "label": "Followup Info", + "isExpanded": "true", + "questions": [ + { + "label": "Followup date", + "type": "obs", + "required": false, + "id": "followupDate", + "questionOptions": { + "rendering": "date", + "concept": "b8cd8630-56dd-495e-8c84-e36a636febe7", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + } + ] + }, + { + "label": "Anthropometric measurements", + "isExpanded": "true", + "questions": [ + { + "label": "Weight (kg)", + "type": "obs", + "required": false, + "id": "weight", + "questionOptions": { + "rendering": "number", + "concept": "5089AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "PIH-Malawi", + "value": "5089" + }, + { + "relationship": "SAME-AS", + "type": "AMPATH", + "value": "5089" + }, + { + "relationship": "BROADER-THAN", + "type": "LOINC", + "value": "3141-9" + }, + { + "relationship": "SAME-AS", + "type": "ANC-DAK", + "value": "ANC.B8.DE3" + }, + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "5089" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "27113001" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "5089" + }, + { + "relationship": "SAME-AS", + "type": "org.openmrs.module.mdrtb", + "value": "WEIGHT" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Length (cm)", + "type": "obs", + "required": false, + "id": "length", + "questionOptions": { + "rendering": "number", + "concept": "78230f35-d01c-48de-9ce3-8a0065a305bb", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + }, + { + "label": "Head circumference (cm)", + "type": "obs", + "required": false, + "id": "headCircumference (cm)", + "questionOptions": { + "rendering": "number", + "concept": "5314AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "AMPATH", + "value": "5314" + }, + { + "relationship": "BROADER-THAN", + "type": "LOINC", + "value": "8287-5" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-CT", + "value": "363812007" + }, + { + "relationship": "SAME-AS", + "type": "IMO-ProcedureIT", + "value": "29947201" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "5314" + } + ], + "answers": [] + }, + "validators": [] + } + ] + }, + { + "label": "Infant Development", + "isExpanded": "true", + "questions": [ + { + "label": "Growth pattern", + "type": "obs", + "required": false, + "id": "growthPattern", + "questionOptions": { + "rendering": "radio", + "concept": "eea6b3e8-efc6-448e-9d01-c2462e2cf727", + "conceptMappings": [], + "answers": [ + { + "concept": "1115AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Normal" + }, + { + "concept": "2580f731-d86a-4876-8550-eacd0f7755be", + "label": "Growth failure" + } + ] + }, + "validators": [] + }, + { + "label": "Reason for growth failure", + "type": "obs", + "required": false, + "id": "reasonForGrowthFailure", + "questionOptions": { + "rendering": "select", + "concept": "bbf0b810-d865-481c-8012-c446e1679fbd", + "conceptMappings": [], + "answers": [ + { + "concept": "262dcf2e-eac0-4577-9554-b43ef1ec9cd9", + "label": "Crossing two percentile" + }, + { + "concept": "ec45263a-ea42-459a-b6b1-38d2c7565d67", + "label": "Weight for age >3 percentile" + }, + { + "concept": "3937c003-ce94-44e9-8ce6-c46b53179530", + "label": "Length for age >3 percentile" + }, + { + "concept": "e60698a9-61d1-4b65-993f-82771fcd8761", + "label": "Head circumference <-3 SD" + } + ] + }, + "validators": [] + }, + { + "label": "Development milestone", + "type": "obs", + "required": false, + "id": "developmentMilestone", + "questionOptions": { + "rendering": "radio", + "concept": "d646c980-b04d-46a0-8a49-4800506ad64c", + "conceptMappings": [], + "answers": [ + { + "concept": "1115AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Normal" + }, + { + "concept": "6022AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Delayed milestones" + } + ] + }, + "validators": [] + }, + { + "label": "Reason for red flag", + "type": "obs", + "required": false, + "id": "reasonForRedFlag", + "questionOptions": { + "rendering": "select", + "concept": "104e6fa9-efb5-4be9-b115-415e96671ab5", + "conceptMappings": [], + "answers": [ + { + "concept": "f2e1e852-57e1-4f9b-97eb-10922b00b43a", + "label": "2 months : Unable to smile in response to your smile" + }, + { + "concept": "72483e1b-e737-43f9-a2df-9f0c30d46ad6", + "label": "3 months: Does not respond to sound by quieting" + }, + { + "concept": "b5b0e154-8802-414a-9640-626524b33b4e", + "label": "4 months: Does not grasp rattle put into palm or hold head steady when you sit him up" + }, + { + "concept": "09b3775f-027c-47c2-9648-ecc13dc9166f", + "label": "6 months: Does not reach for object held at eye level in front of him" + }, + { + "concept": "aebfcd87-e3df-4e72-9a54-eee61137dae0", + "label": "9 months: Does not bear weight and stand with hands held" + }, + { + "concept": "bdded679-3e99-460b-bd8b-3bdc1de4b740", + "label": "12 months: Does not stand alone" + }, + { + "concept": "ae95b72b-a489-4d4f-82fc-e403c25487ae", + "label": "14 months: Inability to walk alone" + }, + { + "concept": "2c8678b1-67ba-4ab9-ae07-8bf581d0b566", + "label": "15 months: Does not use one work meaningfully" + }, + { + "concept": "bd9a2472-6bff-4b01-aafc-0e4cf2f26345", + "label": "18 months: Does not use atleast 3 words, does not point to what he wants" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "Infant Feeding Practice", + "isExpanded": "true", + "questions": [ + { + "label": "Feeding practice for infant less than 6 months", + "type": "obs", + "required": false, + "id": "feedingPracticeForInfantLessThan6Months", + "questionOptions": { + "rendering": "select", + "concept": "164858AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "164858" + } + ], + "answers": [ + { + "concept": "164857AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Exclusive replacement feeding" + }, + { + "concept": "5526AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Breastfed exclusively" + }, + { + "concept": "6046AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Mixed feeding" + } + ] + }, + "validators": [] + }, + { + "label": "Feeding practice for infant older than 6 months", + "type": "obs", + "required": false, + "id": "feedingPracticeForInfantOlderThan6Months", + "questionOptions": { + "rendering": "radio", + "concept": "db416d1c-d29b-4257-8cd7-76ff835845c5", + "conceptMappings": [], + "answers": [ + { + "concept": "6046AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Mixed feeding" + }, + { + "concept": "1595AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Replacement feeding" + } + ] + }, + "validators": [] + }, + { + "label": "Other breast condition", + "type": "obs", + "required": false, + "id": "otherBreastCondition", + "questionOptions": { + "rendering": "text", + "concept": "00ed2ac0-aacc-402b-b587-7a4bbe1321d5", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + }, + { + "label": "Abnormal findings", + "type": "obs", + "required": false, + "id": "abnormalFindings", + "questionOptions": { + "rendering": "select", + "concept": "a9ddac88-830f-438d-bdff-fc492e9de8b1", + "conceptMappings": [], + "answers": [ + { + "concept": "ba3c5c14-beab-4284-80eb-e7b7f921802f", + "label": "Generalized lymphadenopathy" + }, + { + "concept": "5334AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Candidiasis, oral" + }, + { + "concept": "5018AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Diarrhea, chronic" + }, + { + "concept": "825AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Hepatosplenomegaly" + }, + { + "concept": "55849119-c6c6-419d-a1fb-e019c4b7fe14", + "label": "Persistent fever" + }, + { + "concept": "6b509110-fea2-4b2c-b340-e83a7aab8e10", + "label": "Pneumonia or lower respiratory tract infections" + }, + { + "concept": "09b3e279-11ff-4d52-ab6d-e668139defa5", + "label": "Purulent ear discharge" + }, + { + "concept": "d1301939-1a0d-4afb-956d-3cd82da39496", + "label": "Severe skin lesions" + }, + { + "concept": "1107AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "None" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other" + } + ] + }, + "validators": [] + }, + { + "label": "Other abnormal finding", + "type": "obs", + "required": false, + "id": "otherAbnormalFinding", + "questionOptions": { + "rendering": "text", + "concept": "03cd50c0-827d-47b4-92cb-12c8181ce84a", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + }, + { + "label": "Mother's breast condition", + "type": "obs", + "required": false, + "id": "mothersBreastCondition", + "questionOptions": { + "rendering": "select", + "concept": "5efb8e8d-36e1-4eef-9a50-d59ce5d50d7d", + "conceptMappings": [], + "answers": [ + { + "concept": "b3e08818-e665-453a-b046-1aac1e3ed8c4", + "label": "Normal Mastitis" + }, + { + "concept": "243f42c7-ecab-4d73-a2f9-15c8a4999f24", + "label": "Cracked nipples" + }, + { + "concept": "ec4886c3-b2c7-41ff-af66-f5d1519c35eb", + "label": "Breast abscess" + }, + { + "concept": "5622AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Other" + } + ] + }, + "validators": [] + } + ] + } + ] + }, + { + "label": "Treatment / HIV Test", + "sections": [ + { + "label": "HIV Test", + "isExpanded": "true", + "questions": [ + { + "label": "HIV test done", + "type": "obs", + "required": false, + "id": "hivTestDone", + "questionOptions": { + "rendering": "radio", + "concept": "164401AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "164401" + } + ], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + }, + "validators": [] + }, + { + "label": "Test round", + "type": "obs", + "required": false, + "id": "testRound", + "questionOptions": { + "rendering": "select", + "concept": "cc8b10f3-a1ff-4d82-8143-a45af803bd56", + "conceptMappings": [], + "answers": [ + { + "concept": "42807db4-c4cc-4dc4-9154-a78e1c867f9f", + "label": "Initial test" + }, + { + "concept": "ce696718-39b5-4838-80f2-44d7cf40c055", + "label": "Diagnostic repeat test" + } + ] + }, + "validators": [] + }, + { + "label": "Result", + "type": "obs", + "required": false, + "id": "result", + "questionOptions": { + "rendering": "radio", + "concept": "159427AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "159427" + }, + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "2169" + }, + { + "relationship": "SAME-AS", + "type": "SNOMED-MVP", + "value": "1594271000105002" + }, + { + "relationship": "SAME-AS", + "type": "org.openmrs.module.mdrtb", + "value": "RESULT OF HIV TEST" + }, + { + "relationship": "NARROWER-THAN", + "type": "SNOMED-CT", + "value": "31676001" + } + ], + "answers": [ + { + "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Positive" + }, + { + "concept": "664AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Negative" + } + ] + }, + "validators": [] + }, + { + "label": "Rapid antibody result", + "type": "obs", + "required": false, + "id": "rapidAntibodyResult", + "questionOptions": { + "rendering": "radio", + "concept": "aa69908a-989a-4fef-ad65-cbd73ba487b7", + "conceptMappings": [], + "answers": [ + { + "concept": "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Positive" + }, + { + "concept": "664AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Negative" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "ARV Drug", + "isExpanded": "true", + "questions": [ + { + "label": "ARV prophylaxis started", + "type": "obs", + "required": false, + "id": "arvProphylaxisStarted", + "questionOptions": { + "rendering": "radio", + "concept": "39238bfb-ea2c-4cec-a395-4d62574da39b", + "conceptMappings": [], + "answers": [ + { + "concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Yes" + }, + { + "concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "No" + } + ] + } + }, + { + "label": "ARV prophylaxis ", + "type": "obs", + "required": false, + "id": "arvProphylaxis", + "questionOptions": { + "rendering": "select", + "concept": "b7f50074-b9f2-4b0d-9f20-d18b646d822e", + "conceptMappings": [], + "answers": [ + { + "concept": "ba262f0d-07c1-49d2-a3b6-27dceaccdaba", + "label": "AZT only for 6 weeks" + }, + { + "concept": "b5b94269-9ee1-4733-8a24-96213cf3c291", + "label": "NVP + AZT for 6 weeks" + }, + { + "concept": "d32ee1d2-2518-478d-bceb-7e80fc8cb3b1", + "label": "NVP only for 6 weeks" + }, + { + "concept": "ae1653d4-4d05-4633-bd92-c5622ddfdc26", + "label": "NVP only for additional 6 weeks" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "Cotrimoxazole Prophylaxis", + "isExpanded": "true", + "questions": [ + { + "label": "Dose", + "type": "obs", + "required": false, + "id": "dose", + "questionOptions": { + "rendering": "select", + "concept": "ec9670c2-ee1f-42db-aea1-d238fb4fc33f", + "conceptMappings": [], + "answers": [ + { + "concept": "fba421cf-a483-4329-b8b1-6a3ef16081bc", + "label": "30" + }, + { + "concept": "75d94023-7804-44f8-9998-9d678488af3e", + "label": "60" + }, + { + "concept": "4abbd98d-0c07-42f4-920c-7bbf0f5824dc", + "label": "90" + }, + { + "concept": "d7b06ad1-b132-4714-baff-b99b2af194a3", + "label": "DC" + } + ] + }, + "validators": [] + }, + { + "label": "Adherence", + "type": "obs", + "required": false, + "id": "adherence", + "questionOptions": { + "rendering": "radio", + "concept": "af63fc87-379b-4fc4-8e68-936026da9f54", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "161652" + } + ], + "answers": [ + { + "concept": "159406AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Fair" + }, + { + "concept": "159405AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Good" + }, + { + "concept": "159407AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Poor" + } + ] + }, + "validators": [] + }, + { + "label": "Treatment / Medication given", + "type": "obs", + "required": false, + "id": "treatmentMedicationGiven", + "questionOptions": { + "rendering": "text", + "concept": "9fc090d6-d646-40f8-8809-7e2f12a88639", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + }, + { + "label": "Next visit date", + "type": "obs", + "required": false, + "id": "nextVisitDate", + "questionOptions": { + "rendering": "date", + "concept": "c596f199-4d76-4eca-b3c4-ffa631c0aee9", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + } + ] + } + ] + }, + { + "label": "Conclusion / Decision", + "sections": [ + { + "label": "Conclusion / Decision", + "isExpanded": "true", + "questions": [ + { + "label": "Conclusion", + "type": "obs", + "required": false, + "id": "conclusion", + "questionOptions": { + "rendering": "select", + "concept": "19c28608-a5c5-4095-8966-4ddac6f93847", + "conceptMappings": [], + "answers": [ + { + "concept": "57bdda27-1e18-4716-b860-735a045e52bd", + "label": "No clinical or laboratory evidence of HIV" + }, + { + "concept": "c8cde5eb-ef6e-4740-80f9-e879279a3c19", + "label": "Clinical evidence of HIV" + }, + { + "concept": "198731de-2a03-418d-a0ba-833accb88f58", + "label": "Laboratory evidence of HIV (DNA PCR/ Antibody tests)" + }, + { + "concept": "160034AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "label": "Died" + } + ] + }, + "validators": [] + }, + { + "label": "Decision", + "type": "obs", + "required": false, + "id": "decision", + "questionOptions": { + "rendering": "select", + "concept": "f0652b88-d1dd-4ec5-add7-8bdda63b5a8a", + "conceptMappings": [], + "answers": [ + { + "concept": "041eed6b-3684-4a7d-903b-a44705fdb50f", + "label": "Continue to followup" + }, + { + "concept": "5425b021-8539-420b-ad60-4636e98034f2", + "label": "Referred pediatric HIV care outside facility" + }, + { + "concept": "bd5d0757-95f8-4fcb-bd1a-f24953efeca3", + "label": "Referred for pediatric HIV care within facility" + }, + { + "concept": "00c3deda-9bb6-490f-821b-75ba9cc85db5", + "label": "Discharged negative form care (HIV free)" + } + ] + }, + "validators": [] + } + ] + }, + { + "label": "Referral Information", + "isExpanded": "true", + "questions": [ + { + "label": "Provider name", + "type": "obs", + "required": false, + "id": "providerName", + "questionOptions": { + "rendering": "text", + "concept": "1473AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "PIH", + "value": "1392" + }, + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "1473" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Provider telephone number", + "type": "obs", + "required": false, + "id": "providerTelephoneNumber", + "questionOptions": { + "rendering": "text", + "concept": "5587f1b1-1917-4345-a284-a0ed6a56a522", + "conceptMappings": [], + "answers": [] + }, + "validators": [] + }, + { + "label": "Referred to", + "type": "obs", + "required": false, + "id": "referredTo", + "questionOptions": { + "rendering": "text", + "concept": "161562AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "161562" + } + ], + "answers": [] + }, + "validators": [] + }, + { + "label": "Referred date", + "type": "obs", + "required": false, + "id": "referredDate", + "questionOptions": { + "rendering": "date", + "concept": "161561AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", + "conceptMappings": [ + { + "relationship": "SAME-AS", + "type": "CIEL", + "value": "161561" + } + ], + "answers": [] + }, + "validators": [] + } + ] + } + ] + } + ] +} \ No newline at end of file