SMART DAK Cervical Cancer Screening
0.0.1 - ci-build
SMART DAK Cervical Cancer Screening, published by Dan Heslinga (independent contributor). This guide is not an authorized publication; it is the continuous build for version 0.0.1 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/dhes/smart-dak-cxca/ and changes regularly. See the Directory of published versions
| Draft as of 2026-05-14 |
<CodeSystem xmlns="http://hl7.org/fhir">
<id value="CXCA.D"/>
<text>
<status value="generated"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p class="res-header-id"><b>Generated Narrative: CodeSystem CXCA.D</b></p><a name="CXCA.D"> </a><a name="hcCXCA.D"> </a><p>This case-sensitive code system <code>http://smart.who.int/cxca/CodeSystem/CXCA.D</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">DE1<a name="CXCA.D-DE1"> </a></td><td>Target age 35 for HPV screening</td><td>First binding age at which a woman becomes a target for primary HPV high-risk DNA screening per Mongolia MOH Order A/641 (2020) section 2.2 (HPV-test-capable facilities).</td></tr><tr><td style="white-space:nowrap">DE2<a name="CXCA.D-DE2"> </a></td><td>Target age 45 for HPV screening</td><td>Second binding age at which a woman becomes a target for primary HPV high-risk DNA screening per Mongolia MOH Order A/641 (2020) section 2.2 (HPV-test-capable facilities).</td></tr><tr><td style="white-space:nowrap">DE3<a name="CXCA.D-DE3"> </a></td><td>HPV high-risk DNA test</td><td>A laboratory test that detects high-risk human papillomavirus DNA from a cervical sample. The careHPV test (used in the April 2026 Khan-Uul pilot) is one such platform. Detects 14 high-risk HPV genotypes in pooled form.</td></tr><tr><td style="white-space:nowrap">DE4<a name="CXCA.D-DE4"> </a></td><td>Due for HPV screening</td><td>Eligibility outcome: the client meets the criteria to be offered HPV high-risk DNA screening at this encounter.</td></tr><tr><td style="white-space:nowrap">DE5<a name="CXCA.D-DE5"> </a></td><td>Not due — already screened in current cycle</td><td>Eligibility outcome: the client is in the target age range, but has had a recent valid HPV screening result and is not due for re-screening at this encounter.</td></tr><tr><td style="white-space:nowrap">DE6<a name="CXCA.D-DE6"> </a></td><td>Excluded — outside target age range</td><td>Eligibility outcome: the client is not in the binding target age range (per A/641 section 2.2). For HPV-test-capable facilities, the binding ages are 35 and 45 only.</td></tr><tr><td style="white-space:nowrap">DE7<a name="CXCA.D-DE7"> </a></td><td>Excluded — prior hysterectomy</td><td>Eligibility outcome: the client has had a hysterectomy for non-cervical-cancer indication with a documented negative post-operative vaginal-smear cytology, and is therefore exempt from cervical cancer screening per A/641 section 2.2.</td></tr><tr><td style="white-space:nowrap">DE8<a name="CXCA.D-DE8"> </a></td><td>HPV high-risk positive</td><td>Result: at least one high-risk human papillomavirus genotype detected in the cervical sample.</td></tr><tr><td style="white-space:nowrap">DE9<a name="CXCA.D-DE9"> </a></td><td>HPV high-risk negative</td><td>Result: no high-risk human papillomavirus genotypes detected in the cervical sample.</td></tr><tr><td style="white-space:nowrap">DE10<a name="CXCA.D-DE10"> </a></td><td>Lost to follow-up</td><td>Service was expected (e.g., follow-up cytology after a positive HPV result) but did not occur because the patient could not be contacted or did not return for care. Generic LTFU reason; specific causes (phone disconnected, distance, declined) may be added as sub-codes in future iterations.</td></tr><tr><td style="white-space:nowrap">DE13<a name="CXCA.D-DE13"> </a></td><td>Cervical cytology test</td><td>A laboratory test in which cervical cells are collected, stained (Papanicolaou or liquid-based), and examined microscopically. Used as a primary screening test in cytology-only facilities (per A/641 section 2.2 cytology pathway) and as a follow-up to a positive HPV result (per A/641 Fig 2.4).</td></tr><tr><td style="white-space:nowrap">DE17<a name="CXCA.D-DE17"> </a></td><td>HIV-positive</td><td>Client has a documented positive HIV test or active HIV diagnosis. Per WHO Mongolia, women living with HIV are approximately 6× more likely to develop cervical cancer; HIV+ status is a significant risk modifier for screening intensity and follow-up urgency.</td></tr><tr><td style="white-space:nowrap">DE18<a name="CXCA.D-DE18"> </a></td><td>HIV-negative</td><td>Client has a documented negative HIV test.</td></tr><tr><td style="white-space:nowrap">DE19<a name="CXCA.D-DE19"> </a></td><td>HIV status unknown</td><td>Client's HIV status has not been documented. May warrant offering HIV testing alongside cervical cancer screening.</td></tr><tr><td style="white-space:nowrap">DE20<a name="CXCA.D-DE20"> </a></td><td>Current smoker</td><td>Client currently smokes tobacco (any amount, any form).</td></tr><tr><td style="white-space:nowrap">DE21<a name="CXCA.D-DE21"> </a></td><td>Former smoker</td><td>Client has smoked tobacco in the past but has quit.</td></tr><tr><td style="white-space:nowrap">DE22<a name="CXCA.D-DE22"> </a></td><td>Never smoker</td><td>Client has never smoked tobacco.</td></tr><tr><td style="white-space:nowrap">DE23<a name="CXCA.D-DE23"> </a></td><td>Past screening: HPV high-risk DNA test</td><td>Client's most recent prior cervical cancer screening was an HPV high-risk DNA test.</td></tr><tr><td style="white-space:nowrap">DE24<a name="CXCA.D-DE24"> </a></td><td>Past screening: cytology only</td><td>Client's most recent prior cervical cancer screening was cytology (Pap smear) only.</td></tr><tr><td style="white-space:nowrap">DE25<a name="CXCA.D-DE25"> </a></td><td>Past screening: VIA (visual inspection with acetic acid)</td><td>Client's most recent prior cervical cancer screening was VIA. Note: VIA is used in some low-resource settings; it is not part of the A/641 (2020) Mongolia binding pathway but may appear in client history from prior years or other countries.</td></tr><tr><td style="white-space:nowrap">DE26<a name="CXCA.D-DE26"> </a></td><td>Past screening: normal / negative</td><td>Client's most recent prior screening result was normal / negative for cervical pre-cancer or cancer.</td></tr><tr><td style="white-space:nowrap">DE27<a name="CXCA.D-DE27"> </a></td><td>Past screening: abnormal / positive</td><td>Client's most recent prior screening result was abnormal / positive (any abnormality — finer classification not captured at this level).</td></tr><tr><td style="white-space:nowrap">DE28<a name="CXCA.D-DE28"> </a></td><td>Past screening: result unknown</td><td>Client recalls having been screened but cannot recall the result, or the result is not in available records.</td></tr><tr><td style="white-space:nowrap">DE29<a name="CXCA.D-DE29"> </a></td><td>Cytology: NILM (negative for intraepithelial lesion or malignancy)</td><td>Bethesda 2014 NILM. Cytology shows no evidence of pre-cancerous or cancerous change. In the HPV+ pathway this returns the patient to a 1-year repeat HPV cycle per A/641 Fig 2.4.</td></tr><tr><td style="white-space:nowrap">DE30<a name="CXCA.D-DE30"> </a></td><td>Cytology: ASC-US (atypical squamous cells of undetermined significance)</td><td>Bethesda 2014 ASC-US. Atypical squamous cells of undetermined significance. Triggers colposcopy referral in the HPV+ pathway per A/641 Fig 2.4.</td></tr><tr><td style="white-space:nowrap">DE31<a name="CXCA.D-DE31"> </a></td><td>Cytology: ASC-H (atypical squamous cells, cannot exclude HSIL)</td><td>Bethesda 2014 ASC-H. Atypical squamous cells where high-grade squamous intraepithelial lesion (HSIL) cannot be excluded. Triggers colposcopy referral.</td></tr><tr><td style="white-space:nowrap">DE32<a name="CXCA.D-DE32"> </a></td><td>Cytology: LSIL (low-grade squamous intraepithelial lesion)</td><td>Bethesda 2014 LSIL. Low-grade squamous intraepithelial lesion (corresponds to histologic CIN1). Triggers colposcopy referral in the HPV+ pathway.</td></tr><tr><td style="white-space:nowrap">DE33<a name="CXCA.D-DE33"> </a></td><td>Cytology: HSIL (high-grade squamous intraepithelial lesion)</td><td>Bethesda 2014 HSIL. High-grade squamous intraepithelial lesion (corresponds to histologic CIN2 or CIN3). Triggers colposcopy referral with priority.</td></tr><tr><td style="white-space:nowrap">DE34<a name="CXCA.D-DE34"> </a></td><td>Route: return to routine screening</td><td>Routing decision output: no abnormality detected; return the patient to the routine screening cycle per the binding pathway (HPV at 35/45 or cytology at the 11-age cycle).</td></tr><tr><td style="white-space:nowrap">DE35<a name="CXCA.D-DE35"> </a></td><td>Route: repeat HPV test in 12 months</td><td>Routing decision output: HPV+ with negative cytology re-read; repeat the HPV test in 12 months per A/641 Fig 2.4.</td></tr><tr><td style="white-space:nowrap">DE36<a name="CXCA.D-DE36"> </a></td><td>Route: refer to colposcopy</td><td>Routing decision output: HPV+ with cytology ≥ ASC-US, OR HPV+ at 12-month recheck; refer to colposcopy per Op.Inst. 5.6.</td></tr><tr><td style="white-space:nowrap">DE37<a name="CXCA.D-DE37"> </a></td><td>Colposcopy</td><td>A diagnostic procedure in which the cervix is examined under magnification (typically with acetic acid application) to identify lesions for biopsy. Per A/641 Op.Inst. 5.6.</td></tr><tr><td style="white-space:nowrap">DE38<a name="CXCA.D-DE38"> </a></td><td>Recall: HPV sample result timeout (3 weeks)</td><td>Recall trigger: an HPV sample was dispatched to the lab more than 3 weeks ago and no result has been entered into the registry. Per A/641 section 2.3, this triggers a reminder to follow up with the lab and (if the result is in but not yet entered) the entering staff.</td></tr><tr><td style="white-space:nowrap">DE39<a name="CXCA.D-DE39"> </a></td><td>Recall: positive result follow-up timeout (4 weeks)</td><td>Recall trigger: a positive screening result was entered into the registry more than 4 weeks ago and no follow-up examination has been recorded. Per A/641 section 2.3, this triggers a reminder to the patient and the obstetrician-gynaecologist.</td></tr><tr><td style="white-space:nowrap">DE40<a name="CXCA.D-DE40"> </a></td><td>Recall: biopsy result timeout (4 weeks)</td><td>Recall trigger: a biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Per A/641 section 2.3.</td></tr><tr><td style="white-space:nowrap">DE41<a name="CXCA.D-DE41"> </a></td><td>Recall: treatment timeout after positive biopsy (4 weeks)</td><td>Recall trigger: a positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Per A/641 section 2.3.</td></tr><tr><td style="white-space:nowrap">DE42<a name="CXCA.D-DE42"> </a></td><td>Recall: cytology slide unread timeout (2 weeks)</td><td>Recall trigger: a cytology slide was received at the lab more than 2 weeks ago and no cytologist conclusion has been entered. Per A/641 section 2.3.</td></tr><tr><td style="white-space:nowrap">DE43<a name="CXCA.D-DE43"> </a></td><td>Recall: second reminder (4 weeks after first)</td><td>Recall trigger: a first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Per A/641 section 2.3 a second reminder should issue.</td></tr><tr><td style="white-space:nowrap">DE44<a name="CXCA.D-DE44"> </a></td><td>Recall: missed scheduled examination</td><td>Recall trigger: the patient had a scheduled examination that they did not attend. Per A/641 section 2.3, immediate flag — does not wait for a timeout.</td></tr><tr><td style="white-space:nowrap">DE45<a name="CXCA.D-DE45"> </a></td><td>Hysterectomy</td><td>Surgical removal of the uterus. The cervical-cancer-screening exclusion in A/641 section 2.2 applies only when the hysterectomy was for a non-cervical-cancer indication and the post-operative vaginal-smear cytology was negative.</td></tr></table></div>
</text>
<url value="http://smart.who.int/cxca/CodeSystem/CXCA.D"/>
<version value="0.0.1"/>
<name value="CXCA_D"/>
<title value="CXCA Data Dictionary"/>
<status value="draft"/>
<experimental value="false"/>
<date value="2026-05-14T00:50:23+00:00"/>
<publisher value="Dan Heslinga (independent contributor)"/>
<contact>
<name value="Dan Heslinga (independent contributor)"/>
<telecom>
<system value="url"/>
<value value="https://github.com/dhes"/>
</telecom>
</contact>
<description
value="Data elements for the cervical cancer screening Digital Adaptation Kit (DAK). Contains clinical concepts referenced from the screening pathway, recall logic, and pre-cancer management decision tables."/>
<caseSensitive value="true"/>
<content value="complete"/>
<count value="40"/>
<concept>
<code value="DE1"/>
<display value="Target age 35 for HPV screening"/>
<definition
value="First binding age at which a woman becomes a target for primary HPV high-risk DNA screening per Mongolia MOH Order A/641 (2020) section 2.2 (HPV-test-capable facilities)."/>
</concept>
<concept>
<code value="DE2"/>
<display value="Target age 45 for HPV screening"/>
<definition
value="Second binding age at which a woman becomes a target for primary HPV high-risk DNA screening per Mongolia MOH Order A/641 (2020) section 2.2 (HPV-test-capable facilities)."/>
</concept>
<concept>
<code value="DE3"/>
<display value="HPV high-risk DNA test"/>
<definition
value="A laboratory test that detects high-risk human papillomavirus DNA from a cervical sample. The careHPV test (used in the April 2026 Khan-Uul pilot) is one such platform. Detects 14 high-risk HPV genotypes in pooled form."/>
</concept>
<concept>
<code value="DE4"/>
<display value="Due for HPV screening"/>
<definition
value="Eligibility outcome: the client meets the criteria to be offered HPV high-risk DNA screening at this encounter."/>
</concept>
<concept>
<code value="DE5"/>
<display value="Not due — already screened in current cycle"/>
<definition
value="Eligibility outcome: the client is in the target age range, but has had a recent valid HPV screening result and is not due for re-screening at this encounter."/>
</concept>
<concept>
<code value="DE6"/>
<display value="Excluded — outside target age range"/>
<definition
value="Eligibility outcome: the client is not in the binding target age range (per A/641 section 2.2). For HPV-test-capable facilities, the binding ages are 35 and 45 only."/>
</concept>
<concept>
<code value="DE7"/>
<display value="Excluded — prior hysterectomy"/>
<definition
value="Eligibility outcome: the client has had a hysterectomy for non-cervical-cancer indication with a documented negative post-operative vaginal-smear cytology, and is therefore exempt from cervical cancer screening per A/641 section 2.2."/>
</concept>
<concept>
<code value="DE8"/>
<display value="HPV high-risk positive"/>
<definition
value="Result: at least one high-risk human papillomavirus genotype detected in the cervical sample."/>
</concept>
<concept>
<code value="DE9"/>
<display value="HPV high-risk negative"/>
<definition
value="Result: no high-risk human papillomavirus genotypes detected in the cervical sample."/>
</concept>
<concept>
<code value="DE10"/>
<display value="Lost to follow-up"/>
<definition
value="Service was expected (e.g., follow-up cytology after a positive HPV result) but did not occur because the patient could not be contacted or did not return for care. Generic LTFU reason; specific causes (phone disconnected, distance, declined) may be added as sub-codes in future iterations."/>
</concept>
<concept>
<code value="DE13"/>
<display value="Cervical cytology test"/>
<definition
value="A laboratory test in which cervical cells are collected, stained (Papanicolaou or liquid-based), and examined microscopically. Used as a primary screening test in cytology-only facilities (per A/641 section 2.2 cytology pathway) and as a follow-up to a positive HPV result (per A/641 Fig 2.4)."/>
</concept>
<concept>
<code value="DE17"/>
<display value="HIV-positive"/>
<definition
value="Client has a documented positive HIV test or active HIV diagnosis. Per WHO Mongolia, women living with HIV are approximately 6× more likely to develop cervical cancer; HIV+ status is a significant risk modifier for screening intensity and follow-up urgency."/>
</concept>
<concept>
<code value="DE18"/>
<display value="HIV-negative"/>
<definition value="Client has a documented negative HIV test."/>
</concept>
<concept>
<code value="DE19"/>
<display value="HIV status unknown"/>
<definition
value="Client's HIV status has not been documented. May warrant offering HIV testing alongside cervical cancer screening."/>
</concept>
<concept>
<code value="DE20"/>
<display value="Current smoker"/>
<definition
value="Client currently smokes tobacco (any amount, any form)."/>
</concept>
<concept>
<code value="DE21"/>
<display value="Former smoker"/>
<definition value="Client has smoked tobacco in the past but has quit."/>
</concept>
<concept>
<code value="DE22"/>
<display value="Never smoker"/>
<definition value="Client has never smoked tobacco."/>
</concept>
<concept>
<code value="DE23"/>
<display value="Past screening: HPV high-risk DNA test"/>
<definition
value="Client's most recent prior cervical cancer screening was an HPV high-risk DNA test."/>
</concept>
<concept>
<code value="DE24"/>
<display value="Past screening: cytology only"/>
<definition
value="Client's most recent prior cervical cancer screening was cytology (Pap smear) only."/>
</concept>
<concept>
<code value="DE25"/>
<display
value="Past screening: VIA (visual inspection with acetic acid)"/>
<definition
value="Client's most recent prior cervical cancer screening was VIA. Note: VIA is used in some low-resource settings; it is not part of the A/641 (2020) Mongolia binding pathway but may appear in client history from prior years or other countries."/>
</concept>
<concept>
<code value="DE26"/>
<display value="Past screening: normal / negative"/>
<definition
value="Client's most recent prior screening result was normal / negative for cervical pre-cancer or cancer."/>
</concept>
<concept>
<code value="DE27"/>
<display value="Past screening: abnormal / positive"/>
<definition
value="Client's most recent prior screening result was abnormal / positive (any abnormality — finer classification not captured at this level)."/>
</concept>
<concept>
<code value="DE28"/>
<display value="Past screening: result unknown"/>
<definition
value="Client recalls having been screened but cannot recall the result, or the result is not in available records."/>
</concept>
<concept>
<code value="DE29"/>
<display
value="Cytology: NILM (negative for intraepithelial lesion or malignancy)"/>
<definition
value="Bethesda 2014 NILM. Cytology shows no evidence of pre-cancerous or cancerous change. In the HPV+ pathway this returns the patient to a 1-year repeat HPV cycle per A/641 Fig 2.4."/>
</concept>
<concept>
<code value="DE30"/>
<display
value="Cytology: ASC-US (atypical squamous cells of undetermined significance)"/>
<definition
value="Bethesda 2014 ASC-US. Atypical squamous cells of undetermined significance. Triggers colposcopy referral in the HPV+ pathway per A/641 Fig 2.4."/>
</concept>
<concept>
<code value="DE31"/>
<display
value="Cytology: ASC-H (atypical squamous cells, cannot exclude HSIL)"/>
<definition
value="Bethesda 2014 ASC-H. Atypical squamous cells where high-grade squamous intraepithelial lesion (HSIL) cannot be excluded. Triggers colposcopy referral."/>
</concept>
<concept>
<code value="DE32"/>
<display
value="Cytology: LSIL (low-grade squamous intraepithelial lesion)"/>
<definition
value="Bethesda 2014 LSIL. Low-grade squamous intraepithelial lesion (corresponds to histologic CIN1). Triggers colposcopy referral in the HPV+ pathway."/>
</concept>
<concept>
<code value="DE33"/>
<display
value="Cytology: HSIL (high-grade squamous intraepithelial lesion)"/>
<definition
value="Bethesda 2014 HSIL. High-grade squamous intraepithelial lesion (corresponds to histologic CIN2 or CIN3). Triggers colposcopy referral with priority."/>
</concept>
<concept>
<code value="DE34"/>
<display value="Route: return to routine screening"/>
<definition
value="Routing decision output: no abnormality detected; return the patient to the routine screening cycle per the binding pathway (HPV at 35/45 or cytology at the 11-age cycle)."/>
</concept>
<concept>
<code value="DE35"/>
<display value="Route: repeat HPV test in 12 months"/>
<definition
value="Routing decision output: HPV+ with negative cytology re-read; repeat the HPV test in 12 months per A/641 Fig 2.4."/>
</concept>
<concept>
<code value="DE36"/>
<display value="Route: refer to colposcopy"/>
<definition
value="Routing decision output: HPV+ with cytology ≥ ASC-US, OR HPV+ at 12-month recheck; refer to colposcopy per Op.Inst. 5.6."/>
</concept>
<concept>
<code value="DE37"/>
<display value="Colposcopy"/>
<definition
value="A diagnostic procedure in which the cervix is examined under magnification (typically with acetic acid application) to identify lesions for biopsy. Per A/641 Op.Inst. 5.6."/>
</concept>
<concept>
<code value="DE38"/>
<display value="Recall: HPV sample result timeout (3 weeks)"/>
<definition
value="Recall trigger: an HPV sample was dispatched to the lab more than 3 weeks ago and no result has been entered into the registry. Per A/641 section 2.3, this triggers a reminder to follow up with the lab and (if the result is in but not yet entered) the entering staff."/>
</concept>
<concept>
<code value="DE39"/>
<display value="Recall: positive result follow-up timeout (4 weeks)"/>
<definition
value="Recall trigger: a positive screening result was entered into the registry more than 4 weeks ago and no follow-up examination has been recorded. Per A/641 section 2.3, this triggers a reminder to the patient and the obstetrician-gynaecologist."/>
</concept>
<concept>
<code value="DE40"/>
<display value="Recall: biopsy result timeout (4 weeks)"/>
<definition
value="Recall trigger: a biopsy sample was received at the lab more than 4 weeks ago and no histopathology result has been entered. Per A/641 section 2.3."/>
</concept>
<concept>
<code value="DE41"/>
<display
value="Recall: treatment timeout after positive biopsy (4 weeks)"/>
<definition
value="Recall trigger: a positive biopsy result has been entered for more than 4 weeks and no treatment record exists. Per A/641 section 2.3."/>
</concept>
<concept>
<code value="DE42"/>
<display value="Recall: cytology slide unread timeout (2 weeks)"/>
<definition
value="Recall trigger: a cytology slide was received at the lab more than 2 weeks ago and no cytologist conclusion has been entered. Per A/641 section 2.3."/>
</concept>
<concept>
<code value="DE43"/>
<display value="Recall: second reminder (4 weeks after first)"/>
<definition
value="Recall trigger: a first reminder was sent more than 4 weeks ago and the underlying gap remains unresolved. Per A/641 section 2.3 a second reminder should issue."/>
</concept>
<concept>
<code value="DE44"/>
<display value="Recall: missed scheduled examination"/>
<definition
value="Recall trigger: the patient had a scheduled examination that they did not attend. Per A/641 section 2.3, immediate flag — does not wait for a timeout."/>
</concept>
<concept>
<code value="DE45"/>
<display value="Hysterectomy"/>
<definition
value="Surgical removal of the uterus. The cervical-cancer-screening exclusion in A/641 section 2.2 applies only when the hysterectomy was for a non-cervical-cancer indication and the post-operative vaginal-smear cytology was negative."/>
</concept>
</CodeSystem>