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U4X-1042: HMIS ACP 014-Early Infant Diagnosis (EID) Request Form #820

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U4X-1042: HMIS ACP 014-Early Infant Diagnosis (EID) Request Form #820

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HMIS ACP 014: Early Infant Diagnosis (EID) Request Form
semujju Jun 13, 2025
3d7bee9
Remove POC Testing Section
semujju Jun 13, 2025
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277 changes: 277 additions & 0 deletions ...main/webapp/resources/jsonforms/HMIS-ACP-014-Early-Infant-Diagnosis-EID-Request-Form.json
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{
"name": "HMIS ACP 014: Early Infant Diagnosis (EID) Request Form",
"processor": "EncounterFormProcessor",
"encounterType": "5ef205bc-136a-469b-b074-5f39488db91a",
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@semujju why using In Patient Encounter????

"uuid": "f480da00-12f6-4574-b7a0-e9390fb7ead9",
"description": "This form is used to carry out tests on an exposed infant",
"version": "4.1.1",
"published": true,
"retired": false,
"pages": [
{
"label": "Child Information",
"sections": [
{
"label": "Patient Details",
"isExpanded": "true",
"questions": [
{
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "8ea2dd3d-7d16-42f6-b034-5ffe3a4dbc99"
},
"id": "expNumber",
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@semujju Please ensure this field is auto-filled for clients already enrolled in the program, as this is a request form and the value should already be known

"label": "Exp-Number"
},
{
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "c3d744f6-00ef-4774-b9a7-d33c58f5b014",
"answers": [
{
"concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "No"
},
{
"concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Yes"
}
]
},
"id": "givenContrimoxazole",
"label": "Given Contrimoxazole"
},
{
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "c3d744f6-00ef-4774-b9a7-d33c58f5b014",
"answers": [
{
"concept": "1066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "No"
},
{
"concept": "1065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA",
"label": "Yes"
}
]
},
"id": "deliveredAtHealthFacility",
"label": "Delivered at Health Facility"
},
{
"type": "obs",
"questionOptions": {
"rendering": "checkbox",
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@semujju is Entry point multi select or dropdown

"concept": "dcdfe3ce-30ab-102d-86b0-7a5022ba4115",
"answers": [
{
"concept": "dcd87b79-30ab-102d-86b0-7a5022ba4115",
"label": "MEDICAL OUTPATIENT"
},
{
"concept": "dcd68a88-30ab-102d-86b0-7a5022ba4115",
"label": "OTHER SPECIFY"
},
{
"concept": "e9469d61-b0c3-4785-81c6-057c7bc099fc",
"label": "YCC-Young child clinic"
},
{
"concept": "dcd7e8e5-30ab-102d-86b0-7a5022ba4115",
"label": "PMTCT"
}
]
},
"id": "entryPoint",
"label": "Entry Point"
}
]
},
{
"label": "Sample Details",
"isExpanded": "true",
"questions": [
{
"type": "obs",
"questionOptions": {
"rendering": "date",
"concept": "3074a7fa-6b55-4521-8270-1227a63b8b55"
},
"id": "collectionDate",
"label": "Collection Date",
"datePickerFormat": "calendar"
},
{
"type": "obs",
"questionOptions": {
"rendering": "date",
"concept": "cbbc09cc-a7e2-11ed-afa1-0242ac120002"
},
"id": "dispatchDate",
"label": "Dispatch Date",
"datePickerFormat": "calendar"
},
{
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "0e07f19e-9990-4e9a-97ab-8c39f4d9f828",
"answers": [
{
"concept": "dc68b527-30ab-102d-86b0-7a5022ba4115",
"label": "BITE, HUMAN"
},
{
"concept": "97fa712a-0314-47cd-a065-bea8a773790b",
"label": "Condom burst"
},
{
"concept": "6fb83a8c-c898-46ca-9d0a-bc01080fc7c1",
"label": "Defilement"
}
]
},
"id": "typeOfTest",
"label": "Type of Test"
},
{
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "30d24eb0-e8c5-4c2f-a369-ddba9d88e92a",
"answers": [
{
"concept": "f8fc1be7-65ea-4179-8472-d67e9e446b46",
"label": "6 weeks"
},
{
"concept": "7520826e-e098-4bde-b1c8-f08690366a78",
"label": "9 MONTHS"
},
{
"concept": "21f19331-e15f-4b39-8a3c-70499e5b2aae",
"label": "18 Months"
}
]
},
"id": "nonRoutinePCR",
"label": "Non-routine PCR"
}
]
},
{
"label": "Infant Feeding Status At Test",
"isExpanded": "true",
"questions": [
{
"type": "obs",
"questionOptions": {
"rendering": "select",
"concept": "dc9a00a2-30ab-102d-86b0-7a5022ba4115",
"answers": [
{
"concept": "dcbd637e-30ab-102d-86b0-7a5022ba4115",
"label": "BREASTFED EXCLUSIVELY"
},
{
"concept": "dcd5487d-30ab-102d-86b0-7a5022ba4115",
"label": "MIXED FEEDING"
},
{
"concept": "40fdb5b6-e8ac-424d-988c-f2f2937348db",
"label": "REPLACEMENT FEEDING"
},
{
"concept": "dc9a30bc-30ab-102d-86b0-7a5022ba4115",
"label": "WEANED"
}
]
},
"id": "infantFeedingStatusAtTest",
"label": "Infant Feeding Status"
}
]
}
]
},
{
"label": "Mother Information",
"sections": [
{
"label": "Mother Information",
"isExpanded": "true",
"questions": [
{
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "164985AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA"
},
"id": "mothersHTSNo",
"label": "Mother’s HTS No."
},
{
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "105ef9de-ad90-4c08-bcd5-ab48f74f6287"
},
"id": "artNo",
"label": "Art No"
},
{
"type": "obs",
"questionOptions": {
"rendering": "radio",
"concept": "dca25616-30ab-102d-86b0-7a5022ba4115",
"answers": [
{
"concept": "dca2817c-30ab-102d-86b0-7a5022ba4115",
"label": "ON ART"
},
{
"concept": "eeee7b94-8556-4bf8-919f-1fce764f93e6",
"label": "Not On ART"
}
]
},
"id": "artStatus",
"label": "Art Status"
},
{
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "38460266-6bcd-47e8-844c-649d34323810"
},
"id": "antenatal",
"label": "Antenatal"
},
{
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "5b40c070-a7e2-11ed-afa1-0242ac120002"
},
"id": "delivery",
"label": "Delivery"
},
{
"type": "obs",
"questionOptions": {
"rendering": "text",
"concept": "ef1f4c7a-2b90-4412-83bb-87ae8094ce4c"
},
"id": "postnatal",
"label": "Postnatal"
}
]
}
]
}
]
}