HIV Case-reporting for Vietnam - candidate draft
0.1.0-test - CI Build

HIV Case-reporting for Vietnam - candidate draft - Local Development build (v0.1.0-test). See the Directory of published versions

Questionnaire: HIV Case Report Form

Branch:
Structure
LinkIdTextCardinalityTypeDescription & Constraintsdoco
.. hiv_case_report_formHIV Case Report FormQuestionnairehttp://openhie.org/fhir/openhie.vn.case-reporting.hiv/Questionnaire/hiv-case-report-questionnaire#0.1.0-test
... titleHIV case report0..1display
... instructionsReporting instructions: Monthly - applicable to each patient during the reporting period0..1display
... mediatorFrom System0..1choiceValue Set: MediatorSystem Value Set
... facility_idFacility ID0..1open-choice
... report_dateDate of report0..1date
... questionsMonthly report0..1group
.... patient_identificationPart I: Identifying information0..1group
..... patient_cs_nrPatient case surveillance number HIV info number and MPI number0..1string
..... case_uidCase UID - auto generated by Client regsitry0..1string
..... patient_record_uuidCase record UUID from data source system0..1string
..... index_testingIndex testing0..1group
...... index_case_national_id12Link to index national id 12 digits0..1string
...... index_case_national_id9Link to index national id 9 digits0..1string
...... index_case_uidLink to index hivinfo case id0..1string
..... personal_informationPersonal information0..1group
...... fullnameFull name0..1string
...... ethnicityVietnam ethnicity0..1choiceValue Set: Valueset Vietnam Ethnicity
...... genderGender0..1choiceValue Set: Patient Gender
...... birth_dateDate of birth0..1date
...... identificationIdentification0..1group
....... national_id12National ID 12 digits0..1string
....... national_id9National ID 9 digits0..1string
....... insurance_nrHealth insurance number0..1string
....... insurance_exp_dateHealth insurance expiry date0..1date
....... passport_nrPassport number0..1string
....... driver_licenseDriver license0..1string
....... phone_numberPhone number0..1string
...... residenceResidence0..*group
....... current_residenceCurrent residence0..1group
........ countryCountry0..1open-choice
........ provinceProvince0..1open-choice
........ districtDistrict0..1open-choice
........ communeCommune0..1open-choice
........ addressStreet address0..1string
....... permanent_residencePermanent residence0..1group
........ countryCountry0..1open-choice
........ provinceProvince0..1open-choice
........ districtDistrict0..1open-choice
........ communeCommune0..1open-choice
........ addressStreet address0..1string
...... occupationOccupation0..1open-choiceValue Set: Occupation Value Set
...... residence_statusResidence Status0..1choiceValue Set: Valueset ResidenceStatus
.... risk_factorsRisk factors0..1group
..... population_groupPopulation group0..1open-choiceValue Set: Risk Population relevant for HIV
..... risk_behaviorRisk behavior0..1choiceValue Set: Risk Behavior
..... transmission_routeTransmission route0..1choiceValue Set: HIV Transmission Route
.... hiv_diagnosisHIV diagnosis0..1group
..... confirmation_dateDate of confirmation0..1date
..... confirming_labConfirming lab0..1open-choice
..... confirmation_codeConfirming code0..1string
..... date_specimen_collectedDate of specimen collection0..1date
..... place_specimen_collectedPlace of specimen collection0..1open-choice
.... hiv_recency_testHIV recency test0..1group
..... rapid_testRapid test for recent infection0..1group
...... date_specimen_collectedDate of specimen collection0..1date
...... place_specimen_collectedPlace of specimen collection0..1open-choice
...... date_test_performedDate test result validated0..1date
...... test_resultRapid test result0..1choiceValue Set: Valueset Rapid test results
..... vl_testViral load test specific for recency test0..1group
...... date_test_performedDate of recency VL test0..1date
...... test_resultVL test result (copies/mL)0..1integer
...... test_result_otherOther of viral load test (undetectable)0..1choiceOptions: 1 option
..... recent_infection_conclusionRecent infection conclusion0..1choiceValue Set: Valueset Recent infection conclusion
.... cd4_testCD4 test results0..*group
..... test_reasonReason for CD4 test0..1choiceValue Set: Valueset Reason for CD4 test
..... date_specimen_collectedDate of specimen collection for CD4 test0..1date
..... place_specimen_collectedPlace of specimen collection for CD4 test0..1open-choice
..... date_test_performedDate of CD4 test0..1date
..... test_resultResult of CD4 test0..1integer
.... vl_testViral load test (First time and follow-up)0..*group
..... test_reasonReason for VL test0..1open-choiceValue Set: Valueset Reason for VL test
..... place_specimen_collectedPlace of Specimen Collection for viral load test0..1open-choice
..... date_specimen_collectedDate of Specimen Collection for viral load test0..1date
..... date_test_performedDate of viral load test0..1date
..... test_resultResult of viral load test0..1integer
..... test_result_otherResult of other outcome0..1choiceValue Set: ValueSet Viral Load Other Result
.... drug_resistance_testDrug resistance test0..*group
..... date_specimen_collectedDate of specimen collection0..1date
..... date_test_performedDate test results validated0..1date
..... place_specimen_collectedPlace of specimen collection0..1open-choice
..... test_resultDrug resistance test result0..1choice
.... arv_treatmentARV Treatment0..*group
..... initiation_dateDate of ARV treatment initiation0..1date
..... initiation_facilityName of ARV treatment initiation facility0..1open-choice
..... emr_nrPatient electronic medical record number0..1string
..... enrollment_dateDate of ARV Treatment registration0..1date
..... treatment_date_at_facilityTreatment date of this treatment period at facility0..1date
..... enrollment_facilityName of ARV treatment facility0..1open-choice
..... enrollment_typeReason for ARV treatment registration0..1choiceValue Set: ValueSet ARV Enrollment Type
..... facility_transfer_inTransferred-in facility (previous facility)0..1open-choice
..... treatment_stop_dateDate of treatment stop at facility0..1date
..... treatment_stop_reasonReason to stop treatment at facility0..1choiceValue Set: Valueset Reason to stop treatment at facility
..... place_transfer_outTransferred-out facility (next facility)0..1open-choice
..... date_next_appointmentDate of next appointment0..1date
..... date_last_examinationDate of last examination0..1date
..... arv_regimenARV treatment regimen0..*group
...... date_regimen_startedDate regimen started0..1date
...... date_regimen_stoppedDate regimen stopped0..1date
...... regimen_nameRegimen name0..1open-choiceValue Set: ValueSet Vietnam HIV Regimen
...... regimen_lineRegimen line0..1choiceValue Set: ValueSet Vietnam HIV Regimen Line
...... regimen_change_reasonReason to change regimen0..1open-choiceValue Set: Reason for regimen change
..... who_stageWHO Stage0..*group
...... who_clinical stageWHO clinical stage0..1choiceValue Set: ValueSet WHO Stage
...... date_who_stageDate of WHO clinical stage0..1date
..... treatment_statusARV treatment Status0..1choiceValue Set: ValueSet ARV Treatment Status
.... comorbiditiesComorbidities0..1group
..... tuberculosisTuberculosis0..*group
...... tb_diagnosis_dateTB diagnosis date0..1date
...... tb_treatmentTB treatment0..*group
....... date_startedTB treatment date started0..1date
....... date_endedTB treatment date ended0..1date
....... locationPlace TB treatment provided0..1open-choice
...... tptTPT0..*group
....... date_startedDate TPT started0..1date
....... date_endedDate TPT ended0..1date
....... locationPlace TPT provided0..1open-choice
....... tpt_completedTPT completed0..1boolean
..... hbvHBV0..*group
...... hbsag_dateDate of HbsAg test0..1date
...... hbsag_resultResult of HbsAg test0..1choiceOptions: 2 options
...... hbv_vl_dateDate of HBV viral load test0..1date
...... hbv_vl_resultResult of HBV VL test result (copies/mL)0..1integer
...... diagnosis_dateDate of diagnosis test0..1date
...... diagnosis_resultResult of diagnosis test0..1choiceOptions: 2 options
...... treatment_start_dateDate of HBV treatment start0..1date
...... treatment_stop_dateDate of HBV treatment stopped0..1date
...... treatment_locationPlace HBV treatment provided0..1open-choice
..... hcvHCV0..*group
...... anti_hcv_dateDate of anti HCV test0..1date
...... anti_hcv_resultResult of anti HCV test0..1choiceOptions: 2 options
...... diagnosis_dateDate of HCV diagnosis test0..1date
...... diagnosis_resultResult of HCV dianosis test0..1choiceOptions: 2 options
...... vl_diagnosis_dateDate of HCV viral load test0..1date
...... vl_diagnosis_resultResult of HCV viral load test0..1integer
...... treatment_start_dateDate of HCV treatment start0..1date
...... treatment_stop_dateDate of HCV treatment stopped0..1date
...... treatment_locationPlace HCV treatment provided0..1open-choice
.... deathPatient death0..1group
..... dateDate of death0..1date
..... causeCause of death0..1open-choiceValue Set: Cause of death
.... pregnancyPregnancies0..*group
..... date_reportedDate pregnancy reported0..1date
..... delivery_placeDelivery place0..1open-choice
..... place_reportedPlace pregnancy reported0..1open-choice
..... outcomesPregnancy outcome0..1group
...... outcome_codePregnancy outcome code0..1choiceValue Set: HIV Pregnancy outcome
...... delivery_dateDelivery date0..*dateEnable When: outcome_code = 2 (2)
...... gestational_age_at_deliveryGestational age at delivery (weeks)0..*integerEnable When: outcome_code = 2 (2)
...... childBirths0..*groupEnable When: outcome_code = 2 (2)
....... birth_weightChild weight at birth0..1decimal
....... birth_defectsBirth defects0..1boolean
....... hiv_statusHIV status0..1choiceValue Set: Valueset Birth Defects
....... hiv_diagnosis_dateChild HIV diagnosis date0..1dateEnable When: hiv_status = 1 (1)
....... child_arv_start_dateChild ARV start date0..1dateEnable When: hiv_status = 1 (1)
....... child_prophylasisChild prophylasis0..1choiceOptions: 3 options
....... child_prophylasis_start_dateDate child prophylasis started0..1date
....... child_prophylasis_start_placePlace child prophylasis started0..1open-choice
....... child_arvChild ARV status0..1boolean
....... child_arv_placeChild ARV place0..1open-choice

doco Documentation for this format

Option Sets

Answer options for test_result_other

  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#undetectable ("undetectable")

Answer options for hbsag_result

  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#negative ("Negative")
  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#positive ("Positive")

Answer options for diagnosis_result

  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#negative ("Negative")
  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#positive ("Positive")

Answer options for anti_hcv_result

  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#negative ("Negative")
  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#positive ("Positive")

Answer options for diagnosis_result

  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#negative ("Negative")
  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#positive ("Positive")

Answer options for child_prophylasis

  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#yes ("Yes")
  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#no ("No")
  • http://example.org/CodeSystem/casereporting-hiv-vn-casereport-answeroptions#unknown ("Unknown")