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samuelmale/Triage.json

Created April 4, 2023 13:56
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Triage.json
{
"name": "AMPATH POC Triage v1.2",
"uuid": "xxxx",
"processor": "EncounterFormProcessor",
"pages": [
{
"label": "Encounter Details",
"sections": [
{
"label": "Encounter Details",
"isExpanded": "true",
"questions": [
{
"label": "Visit date",
"type": "encounterDatetime",
"required": "true",
"default": "",
"id": "encDate",
"questionOptions": {
"rendering": "date"
},
"validators": [
{
"type": "date"
}
]
},
{
"type": "encounterProvider",
"label": "Provider",
"id": "provider",
"required": "true",
"default": "",
"questionOptions": {
"rendering": "ui-select-extended"
}
},
{
"type": "encounterLocation",
"label": "Facility name (site/satellite clinic required):",
"id": "location",
"required": "true",
"questionOptions": {
"rendering": "ui-select-extended"
}
},
{
"label": "Patient covered by NHIF:",
"id": "nhif",
"questionOptions": {
"rendering": "select",
"concept": "a8b02524-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "8b715fed-97f6-4e38-8f6a-c167a42f8923",
"label": "Yes"
},
{
"concept": "a899e0ac-1350-11df-a1f1-0026b9348838",
"label": "No"
}
]
},
"type": "obs",
"validators": []
},
{
"label": "What is the patient's NHIF status?",
"id": "nhifStatus",
"questionOptions": {
"rendering": "select",
"concept": "548e6743-67c0-4a6b-bb07-b5f799f63bc1",
"answers": [
{
"concept": "b058a9ad-a0e4-4b37-9214-75b8aed1eaa4",
"label": "Active"
},
{
"concept": "dd373348-1a7f-4625-9e69-9904fa1cc9c7",
"label": "Inactive"
}
]
},
"type": "obs",
"validators": [],
"hide": {
"hideWhenExpression": "nhif !== '8b715fed-97f6-4e38-8f6a-c167a42f8923'"
}
},
{
"label": "What insurance do you have?",
"id": "healthInsurance",
"questionOptions": {
"rendering": "select",
"concept": "a8b02524-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "0bfb0150-949b-4625-98b8-b9d8275bcf44",
"label": "Employer based health insurance"
},
{
"concept": "6fac74c3-fe25-4170-92a4-3ecb8859152e",
"label": "Individual private health insurance"
},
{
"concept": "21eb8488-76ae-47ce-a542-bb3038ab05de",
"label": "Zuri health insurance"
},
{
"concept": "a8aaf3e2-1350-11df-a1f1-0026b9348838",
"label": "Other"
}
]
},
"type": "obs",
"validators": [],
"hide": {
"hideWhenExpression": "nhif !== 'a899e0ac-1350-11df-a1f1-0026b9348838'"
}
},
{
"label": "Was this visit scheduled?",
"id": "scheduledVisit",
"questionOptions": {
"rendering": "select",
"concept": "a89ff9a6-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a89b6440-1350-11df-a1f1-0026b9348838",
"label": "Scheduled visit"
},
{
"concept": "a89ff816-1350-11df-a1f1-0026b9348838",
"label": "Unscheduled visit early"
},
{
"concept": "a89ff8de-1350-11df-a1f1-0026b9348838",
"label": "Unscheduled visit late"
}
]
},
"type": "obs",
"validators": []
},
{
"label": "If unscheduled, actual scheduled date",
"id": "actualDate",
"type": "obs",
"required": {
"type": "conditionalRequired",
"message": "Patient visit marked as unscheduled. Please provide the scheduled date.",
"referenceQuestionId": "scheduledVisit",
"referenceQuestionAnswers": [
"a89ff816-1350-11df-a1f1-0026b9348838",
"a89ff8de-1350-11df-a1f1-0026b9348838"
]
},
"questionOptions": {
"rendering": "date",
"concept": "dc1942b2-5e50-4adc-949d-ad6c905f054e"
},
"validators": [
{
"type": "date",
"allowFutureDates": "true"
},
{
"type": "js_expression",
"failsWhenExpression": "!isEmpty(scheduledVisit) && arrayContains(['a89ff816-1350-11df-a1f1-0026b9348838','a89ff8de-1350-11df-a1f1-0026b9348838'], scheduledVisit) && isEmpty(myValue)",
"message": "Patient visit marked as unscheduled. Please provide the scheduled date."
}
],
"hide": {
"hideWhenExpression": "!arrayContains(['a89ff816-1350-11df-a1f1-0026b9348838','a89ff8de-1350-11df-a1f1-0026b9348838'], scheduledVisit)"
}
}
]
},
{
"label": "Child History(Peds Specific)",
"questions": [
{
"label": "If orphaned under age of 18 yrs?",
"historicalExpression": "_.isEmpty(HD.getObject('prevEnc').getValue('a89ad2d2-1350-11df-a1f1-0026b9348838')) ? undefined : HD.getObject('prevEnc').getValue('a89ad2d2-1350-11df-a1f1-0026b9348838')",
"questionOptions": {
"concept": "a89ad2d2-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a899b35c-1350-11df-a1f1-0026b9348838",
"label": "Yes"
},
{
"concept": "a899b42e-1350-11df-a1f1-0026b9348838",
"label": "No"
}
],
"rendering": "select"
},
"type": "obs"
},
{
"label": "Completed school?",
"questionOptions": {
"concept": "a8aaf9dc-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a899b35c-1350-11df-a1f1-0026b9348838",
"label": "Yes"
},
{
"concept": "a899b42e-1350-11df-a1f1-0026b9348838",
"label": "No"
}
],
"rendering": "select"
},
"type": "obs"
}
]
},
{
"label": "PWPs",
"isExpanded": "true",
"questions": [
{
"label": "Civil status:",
"historicalExpression": "HD.getObject('prevEnc').getValue('a899a9f2-1350-11df-a1f1-0026b9348838')",
"questionOptions": {
"rendering": "select",
"concept": "a899a9f2-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a899af10-1350-11df-a1f1-0026b9348838",
"label": "Cohabitating"
},
{
"concept": "a899ad58-1350-11df-a1f1-0026b9348838",
"label": "Divorced"
},
{
"concept": "a8aa76b0-1350-11df-a1f1-0026b9348838",
"label": "Married monogamous"
},
{
"concept": "a8b03712-1350-11df-a1f1-0026b9348838",
"label": "Married polygamous"
},
{
"concept": "a899aba0-1350-11df-a1f1-0026b9348838",
"label": "Separated"
},
{
"concept": "a899ac7c-1350-11df-a1f1-0026b9348838",
"label": "Single"
},
{
"concept": "a899ae34-1350-11df-a1f1-0026b9348838",
"label": "Widowed"
}
]
},
"type": "obs",
"validators": []
},
{
"label": "Discordant couple:",
"required": "true",
"questionOptions": {
"rendering": "select",
"concept": "a8af49d8-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a89ad3a4-1350-11df-a1f1-0026b9348838",
"label": "N/A"
},
{
"concept": "a899b35c-1350-11df-a1f1-0026b9348838",
"label": "Yes"
},
{
"concept": "a899b42e-1350-11df-a1f1-0026b9348838",
"label": "No"
},
{
"concept": "a899b50a-1350-11df-a1f1-0026b9348838",
"label": "Unknown"
}
]
},
"type": "obs",
"validators": []
},
{
"label": "Prevention with positives: At risk population:",
"required": "true",
"questionOptions": {
"rendering": "select",
"concept": "93aa3f1d-1c39-4196-b5e6-8adc916cd5d6",
"answers": [
{
"concept": "a89ad3a4-1350-11df-a1f1-0026b9348838",
"label": "N/A"
},
{
"concept": "5da55301-e28e-4fdf-8b64-02622dedc8b0",
"label": "Client of sex worker"
},
{
"concept": "a89ff438-1350-11df-a1f1-0026b9348838",
"label": "Commercial sex worker"
},
{
"concept": "a8af49d8-1350-11df-a1f1-0026b9348838",
"label": "Discordant couple"
},
{
"concept": "a890d57a-1350-11df-a1f1-0026b9348838",
"label": "IV drug use"
},
{
"concept": "e19c35f0-12f0-46c2-94ea-97050f37b811",
"label": "MSM"
}
]
},
"type": "obs",
"validators": []
},
{
"label": "Prevention with positives: PWP services:",
"required": "true",
"questionOptions": {
"rendering": "select",
"concept": "9ce5dbf0-a141-4ad8-8c9d-cd2bf84fe72b",
"answers": [
{
"concept": "a89ad3a4-1350-11df-a1f1-0026b9348838",
"label": "N/A"
},
{
"concept": "f0a280e8-eb88-41a8-837a-f9949ed1b9cd",
"label": "Condom promotion/provision"
},
{
"concept": "bf51f71e-937c-4da5-ae07-654acf59f5bb",
"label": "Couple counseling"
},
{
"concept": "91f43249-73c7-427c-8300-2038fc0d6be8",
"label": "Needle exchange"
},
{
"concept": "05656545-86be-4605-9527-34fb580534b1",
"label": "Targeted risk reduction"
}
]
},
"type": "obs",
"validators": []
}
]
},
{
"label": "HIV Disclosure",
"isExpanded": "true",
"questions": [
{
"label": "HIV disclosure:",
"historicalExpression": "_.isEmpty(HD.getObject('prevEnc').getValue('cd8ead74-96fc-4764-a9fa-c9ee059c59c5')) ? undefined : HD.getObject('prevEnc').getValue('cd8ead74-96fc-4764-a9fa-c9ee059c59c5')",
"required": "true",
"questionOptions": {
"concept": "cd8ead74-96fc-4764-a9fa-c9ee059c59c5",
"answers": [
{
"concept": "a89ad3a4-1350-11df-a1f1-0026b9348838",
"label": "N/A"
},
{
"concept": "a899ea48-1350-11df-a1f1-0026b9348838",
"label": "Not disclosed"
},
{
"concept": "40c4e9fa-0fc0-4ceb-89d6-1c8cfebb9bae",
"label": "Partially disclosed"
},
{
"concept": "a89c1ef8-1350-11df-a1f1-0026b9348838",
"label": "Disclosure completed"
},
{
"concept": "e30f9b6c-e4b2-4cd0-83be-8d0d487f57fe",
"label": "Acceptance of diagnosis and management ongoing"
},
{
"concept": "a899b50a-1350-11df-a1f1-0026b9348838",
"label": "Unknown"
}
],
"rendering": "select"
},
"type": "obs"
}
]
},
{
"label": "Vital Signs",
"questions": [
{
"type": "obsGroup",
"label": "test group",
"questionOptions": {
"rendering": "group",
"concept": "a899e6d8-1350-11df-a1f1-0026b9348838"
},
"questions": [
{
"label": "BP:Systolic:",
"questionOptions": {
"rendering": "number",
"concept": "a8a65d5a-1350-11df-a1f1-0026b9348838",
"max": "250",
"min": "0"
},
"type": "obs",
"validators": []
},
{
"label": "BP:Diastolic:",
"questionOptions": {
"rendering": "number",
"concept": "a8a65e36-1350-11df-a1f1-0026b9348838",
"max": "200",
"min": "0"
},
"type": "obs",
"validators": []
},
{
"label": "Pulse(Rate/Min):",
"questionOptions": {
"rendering": "number",
"concept": "a8a65f12-1350-11df-a1f1-0026b9348838",
"max": "230",
"min": "0"
},
"type": "obs",
"validators": []
},
{
"label": "RR(Breath/Min):",
"questionOptions": {
"rendering": "number",
"concept": "a8a6f71a-1350-11df-a1f1-0026b9348838"
},
"type": "obs",
"validators": []
},
{
"label": "Temp(C):",
"questionOptions": {
"rendering": "number",
"concept": "a8a65fee-1350-11df-a1f1-0026b9348838",
"max": "43",
"min": "25"
},
"type": "obs",
"validators": []
},
{
"label": "Weight(Kg):",
"id": "weight",
"questionOptions": {
"rendering": "number",
"concept": "a8a660ca-1350-11df-a1f1-0026b9348838",
"max": "150",
"min": "0"
},
"type": "obs",
"validators": []
},
{
"label": "Height(CM):",
"id": "height",
"historicalExpression": "(HD.getObject('prevEnc').getValue('a8a6619c-1350-11df-a1f1-0026b9348838'))",
"questionOptions": {
"rendering": "number",
"concept": "a8a6619c-1350-11df-a1f1-0026b9348838",
"max": "228",
"min": "0"
},
"type": "obs",
"validators": []
},
{
"label": "Weight for height Z-score:",
"id": "weightScore",
"questionOptions": {
"rendering": "number",
"concept": "5099d8a8-36c1-4574-a568-9bc49c15c08c",
"max": "4",
"min": "-4",
"calculate": {
"calculateExpression": "calcWeightForHeightZscore(weightForHeightRef,height,weight)"
}
},
"type": "obs",
"validators": [],
"hide": {
"hideWhenExpression": "age>5"
}
},
{
"label": " Height/length for age Z-score:",
"id": "heightLengthScore",
"questionOptions": {
"rendering": "number",
"concept": "507f48e7-26fc-490b-a521-35d7c5aa8e9f",
"max": "4",
"min": "-4",
"calculate": {
"calculateExpression": "calcHeightForAgeZscore(heightForAgeRef,height,weight)"
}
},
"type": "obs",
"validators": [],
"hide": {
"hideWhenExpression": "age>17"
}
},
{
"label": "Sp02:",
"questionOptions": {
"rendering": "number",
"concept": "a8a66354-1350-11df-a1f1-0026b9348838",
"max": "100",
"min": "0"
},
"type": "obs",
"validators": []
},
{
"label": "BMI:Kg/M2",
"questionOptions": {
"rendering": "number",
"concept": "a89c60c0-1350-11df-a1f1-0026b9348838",
"max": "100",
"min": "0",
"calculate": {
"calculateExpression": "calcBMI(height,weight)"
}
},
"type": "obs",
"validators": [],
"hide": {
"hideWhenExpression": "age<18"
}
},
{
"label": "BMI for age Z-Score:",
"id": "bmiScore",
"questionOptions": {
"rendering": "number",
"concept": "9061e5d5-8478-4d16-be44-bfec05b6705a",
"max": "4",
"min": "-4",
"calculate": {
"calculateExpression": "calcBMIForAgeZscore(bmiForAgeRef,height,weight)"
}
},
"type": "obs",
"validators": [],
"hide": {
"hideWhenExpression": "age<=5 ||age >=17"
}
},
{
"label": "MUAC:MM",
"questionOptions": {
"rendering": "number",
"concept": "a89c6188-1350-11df-a1f1-0026b9348838",
"max": "450",
"min": "60"
},
"type": "obs",
"validators": []
}
]
}
]
},
{
"label": "General History (Ped/Youth Specific)",
"isExpanded": "true",
"questions": [
{
"type": "obsGroup",
"label": "Person bringing patient",
"questionOptions": {
"concept": "a8a0798a-1350-11df-a1f1-0026b9348838",
"rendering": "group"
},
"questions": [
{
"label": "Person bringing patient:",
"questionOptions": {
"concept": "a898c01e-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a898c0dc-1350-11df-a1f1-0026b9348838",
"label": "Mother"
},
{
"concept": "a898c1a4-1350-11df-a1f1-0026b9348838",
"label": "Father"
},
{
"concept": "a898c262-1350-11df-a1f1-0026b9348838",
"label": "Sibling"
},
{
"concept": "a8a171a0-1350-11df-a1f1-0026b9348838",
"label": "Childrens home"
},
{
"concept": "a89defe4-1350-11df-a1f1-0026b9348838",
"label": "Child"
},
{
"concept": "a89c9f54-1350-11df-a1f1-0026b9348838",
"label": "Paternal grandparent"
},
{
"concept": "a89c9e3c-1350-11df-a1f1-0026b9348838",
"label": "Maternal grandparent"
},
{
"concept": "a898c6f4-1350-11df-a1f1-0026b9348838",
"label": "Self"
},
{
"concept": "a89ebc80-1350-11df-a1f1-0026b9348838",
"label": "Spouse"
},
{
"concept": "a8a17470-1350-11df-a1f1-0026b9348838",
"label": "Paternal aunt"
},
{
"concept": "a8a17394-1350-11df-a1f1-0026b9348838",
"label": "Maternal aunt"
},
{
"concept": "a8a175f6-1350-11df-a1f1-0026b9348838",
"label": "Paternal uncle"
},
{
"concept": "a8a1752e-1350-11df-a1f1-0026b9348838",
"label": "Maternal uncle"
},
{
"concept": "a8aaf3e2-1350-11df-a1f1-0026b9348838",
"label": "Other"
}
],
"rendering": "select"
},
"type": "obs"
}
]
},
{
"label": "Patient changed their residence:",
"questionOptions": {
"rendering": "select",
"concept": "d9a414af-021b-459f-bcea-4c88b1382e39",
"answers": [
{
"concept": "a899b35c-1350-11df-a1f1-0026b9348838",
"label": "Yes"
},
{
"concept": "a899b42e-1350-11df-a1f1-0026b9348838",
"label": "No"
}
]
},
"type": "obs"
},
{
"label": "Mother deceased:",
"historicalExpression": "_.isEmpty(HD.getObject('prevEnc').getValue('a8a0b670-1350-11df-a1f1-0026b9348838')) ? undefined : HD.getObject('prevEnc').getValue('a8a0b670-1350-11df-a1f1-0026b9348838')",
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "a8a0b670-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a899b35c-1350-11df-a1f1-0026b9348838",
"label": "Yes"
},
{
"concept": "a899b42e-1350-11df-a1f1-0026b9348838",
"label": "No"
}
]
},
"validators": []
},
{
"label": "Father deceased:",
"historicalExpression": "_.isEmpty(HD.getObject('prevEnc').getValue('a8a0b788-1350-11df-a1f1-0026b9348838')) ? undefined : HD.getObject('prevEnc').getValue('a8a0b788-1350-11df-a1f1-0026b9348838')",
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "a8a0b788-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a899b35c-1350-11df-a1f1-0026b9348838",
"label": "Yes"
},
{
"concept": "a899b42e-1350-11df-a1f1-0026b9348838",
"label": "No"
}
]
},
"validators": []
}
]
},
{
"label": "Assessment Notes",
"isExpanded": "true",
"questions": [
{
"label": "Please enter the assessment below:",
"type": "obs",
"id": "assNote",
"required": "false",
"default": "",
"questionOptions": {
"concept": "23f710cc-7f9c-4255-9b6b-c3e240215dba",
"rendering": "textarea",
"rows": 5
}
}
]
}
]
},
{
"label": "Family History",
"sections": [
{
"label": "Family History",
"questions": [
{
"label": "Family History",
"type": "obsGroup",
"questionOptions": {
"concept": "aeddf768-5ac0-45e4-934b-bf69730a8c2d",
"rendering": "repeating"
},
"questions": [
{
"label": "Age of family member:",
"type": "obs",
"questionOptions": {
"rendering": "number",
"concept": "d67c7f03-7559-46bd-972b-6520769ec2b7",
"answers": []
},
"validators": []
},
{
"label": "Relation:",
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "2ec6c229-afb6-4d95-89d2-c2f5e2715e9a",
"answers": [
{
"concept": "a898c0dc-1350-11df-a1f1-0026b9348838",
"label": "Mother"
},
{
"concept": "a898c1a4-1350-11df-a1f1-0026b9348838",
"label": "Father"
},
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
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"label": "No"
},
{
"concept": "a89ad3a4-1350-11df-a1f1-0026b9348838",
"label": "N/A"
}
]
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "isEmpty(myValue) && age <=14",
"message": "Patient selected is pediatric. Please provide relationship information."
}
],
"hide": {
"hideWhenExpression": "age>14"
}
},
{
"label": "If yes for siblings < 18 months, are they registered in pediatric HIV clinic:",
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "a8a0bd00-1350-11df-a1f1-0026b9348838",
"answers": [
{
"concept": "a899b35c-1350-11df-a1f1-0026b9348838",
"label": "Yes"
},
{
"concept": "a899b42e-1350-11df-a1f1-0026b9348838",
"label": "No"
},
{
"concept": "a899b50a-1350-11df-a1f1-0026b9348838",
"label": "Unknown"
}
]
},
"validators": [
{
"type": "js_expression",
"failsWhenExpression": "isEmpty(myValue) && age <=14",
"message": "Patient selected is pediatric. Please provide relationship information."
}
],
"hide": {
"hideWhenExpression": "age>14"
}
}
]
}
]
}
]
}
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