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‎omod/src/main/webapp/resources/jsonforms/HMIS ACP 029: SAFE MALE CIRCUMCISION CLIENT FORM.json‎

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{
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"encounterType": "244da86d-f80e-48fe-aba9-067f241905ee",
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"name": "HMIS ACP 029: SAFE MALE CIRCUMCISION CLIENT FORM",
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"processor": "EncounterFormProcessor",
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"referencedForms": [],
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"uuid": "e0208f1d-43ab-4e01-b759-0ea5057c8955",
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"version": "4.0.0",
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"pages": [
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{
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"label": "HMIS ACP 029: SAFE MALE CIRCUMCISION CLIENT FORM",
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"sections": [
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{
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"label": "CLIENT INFORMATION",
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"isExpanded": "true",
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"questions": [
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{
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"label": "How did you know about SMC?",
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"type": "obs",
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"required": false,
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"id": "knowSMC",
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"questionOptions": {
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"rendering": "text",
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"concept": "a-system-defined-concept-uuid"
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}
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},
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{
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"label": "Care Entry Point SMC ",
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"type": "obs",
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"required": false,
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"id": "careEntryPointSmc",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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}
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]
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},
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{
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"label": "CLIENT MEDICAL HISTORY",
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"isExpanded": "true",
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"questions": [
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{
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"label": "Knowledge of HIV Status",
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"type": "obs",
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"required": false,
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"id": "knowledgeOfHivStatus",
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"questionOptions": {
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"rendering": "radio",
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"concept": "system-defined-concept-uuid",
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"answers": [
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{
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"concept": "another-system-defined-concept-uuid",
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"label": "Choice 1",
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"conceptMappings": []
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},
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{
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"concept": "yet-another-system-defined-concept-uuid",
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"label": "Choice 2",
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"conceptMappings": []
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},
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{
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"concept": "yet-one-more-system-defined-concept-uuid",
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"label": "Choice 3",
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"conceptMappings": []
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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": "Medical History",
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"type": "obs",
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"required": false,
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"id": "medicalHistory",
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"questionOptions": {
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"rendering": "radio",
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"concept": "system-defined-concept-uuid",
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"answers": [
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{
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"concept": "another-system-defined-concept-uuid",
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"label": "Choice 1",
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"conceptMappings": []
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},
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{
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"concept": "yet-another-system-defined-concept-uuid",
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"label": "Choice 2",
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"conceptMappings": []
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},
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{
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"concept": "yet-one-more-system-defined-concept-uuid",
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"label": "Choice 3",
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"conceptMappings": []
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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": "Client Undergoing Treatment",
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"type": "obs",
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"required": false,
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"id": "clientUndergoingTreatment",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Allergies",
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"type": "obs",
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"required": false,
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"id": "allergies",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Physical Exam",
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"type": "obs",
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"required": false,
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"id": "physicalExam",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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}
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]
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},
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{
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"label": "ELIGIBILITY FOR CIRCUMCISION",
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"isExpanded": "true",
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"questions": [
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{
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"label": "Client Counseled about SMC? ",
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"type": "obs",
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"required": false,
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"id": "clientCouncelledAboutSMC",
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"questionOptions": {
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"rendering": "radio",
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"concept": "system-defined-concept-uuid",
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"answers": [
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{
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"concept": "another-system-defined-concept-uuid",
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"label": "Choice 1",
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"conceptMappings": []
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},
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{
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"concept": "yet-another-system-defined-concept-uuid",
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"label": "Choice 2",
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"conceptMappings": []
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},
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{
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"concept": "yet-one-more-system-defined-concept-uuid",
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"label": "Choice 3",
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"conceptMappings": []
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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": "Informed consent/ assent for SMC given? ",
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"type": "obs",
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"required": false,
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"id": "informedConsent/AssentForSmcGiven?",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Client Eligible for circumcission after history/physical exam",
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"type": "obs",
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"required": false,
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"id": "clientEligibleForCircumcissionAfterHistory/PhysicalExam",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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}
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]
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},
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{
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"label": "CIRCUMCISION PROCEDURE",
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"isExpanded": "true",
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"questions": [
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{
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"label": "Date of circumcision",
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"type": "obs",
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"required": false,
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"id": "dateOfCircumcission",
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"questionOptions": {
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"rendering": "radio",
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"concept": "system-defined-concept-uuid",
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"answers": [
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{
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"concept": "another-system-defined-concept-uuid",
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"label": "Choice 1",
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"conceptMappings": []
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},
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{
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"concept": "yet-another-system-defined-concept-uuid",
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"label": "Choice 2",
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"conceptMappings": []
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},
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{
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"concept": "yet-one-more-system-defined-concept-uuid",
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"label": "Choice 3",
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"conceptMappings": []
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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": "Type of Anesthesia",
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"type": "obs",
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"required": false,
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"id": "typeOfAnesthesia",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Type of circumcision ",
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"type": "obs",
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"required": false,
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"id": "typeOfCircumcision",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Instruments used: Procedure",
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"type": "obs",
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"required": false,
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"id": "instrumentsUsed:Procedure",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Name of Circumciser: ",
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"type": "obs",
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"required": false,
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"id": "nameOfCircumciser:",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Adverse events during procedure?",
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"type": "obs",
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"required": false,
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"id": "adverseEventsDuringProcedure?",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "If yes, refer to the SMC Adverse Event form",
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"type": "obs",
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"required": false,
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"id": "ifYes,ReferToTheSmcAdverseEventForm",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Type of AE",
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"type": "obs",
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"required": false,
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"id": "typeOfAe",
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"questionOptions": {
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"rendering": "select"
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},
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"validators": []
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},
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{
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"label": "Severity",
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"type": "obs",
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"required": false,
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"id": "severity",
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"questionOptions": {
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"rendering": "checkbox"
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},
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"validators": []
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}
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]
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},
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{
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"label": " CIRCUMCISION FOLLOW UP VISITS",
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"isExpanded": "true",
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"questions": [
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{
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"id": "anotherSampleQuestion",
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"label": "Another Question of type obs whose answers get rendered as radio inputs",
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"type": "obs",
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"questionOptions": {
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"rendering": "radio",
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"concept": "system-defined-concept-uuid",
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"answers": [
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{
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"concept": "another-system-defined-concept-uuid",
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"label": "Choice 1",
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"conceptMappings": []
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},
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{
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"concept": "yet-another-system-defined-concept-uuid",
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"label": "Choice 2",
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"conceptMappings": []
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},
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{
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"concept": "yet-one-more-system-defined-concept-uuid",
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"label": "Choice 3",
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"conceptMappings": []
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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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"description": "A form to collect smc information"
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}

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