Generated Narrative: StructureDefinition CXCAD1 Name Flags Card. Type Description & Constraints <a href="StructureDefinition-CXCAD1-definitions.html#CXCAD1" title="Logical model for the first-encounter intake / anamnesis used at the start of a cervical cancer screening encounter. Mirrors A/641 (2020) Op.Inst. 5.1 (p. 105). Paired with QCXCAD1 Questionnaire for data capture; the eventual SDC StructureMap will extract a filled-in QuestionnaireResponse into FHIR resources conforming to vendored smart-core profiles.">CXCAD1 <a style="padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;; padding-left: 3px; padding-right: 3px; border: 1px maroon solid; font-weight: bold; color: #301212; background-color: #fdf4f4;" href="http://hl7.org/fhir/R4/conformance-rules.html#constraints" title="This element has or is affected by constraints ( cxca-d1-pregnant-needs-gestational-age, cxca-d1-hiv-positive-needs-art-status, cxca-d1-hysterectomy-needs-indication, cxca-d1-screening-date-not-future )">C 0..* Base CXCA.D1 — Cervical Cancer Screening Anamnesis Constraints: cxca-d1-pregnant-needs-gestational-age, cxca-d1-hiv-positive-needs-art-status, cxca-d1-hysterectomy-needs-indication, cxca-d1-screening-date-not-future #xD; clientAge 1..1 integer Client's age in years on the encounter date #xD; clientEducation 0..1 string Client's highest level of education completed (free text in this iteration; may be coded against an ISCED valueset in a future iteration) #xD; numberOfPregnancies 0..1 integer Number of pregnancies (gravidity), regardless of outcome #xD; numberOfBirths 0..1 integer Number of live births (parity) #xD; lastMenstrualPeriod 0..1 date First day of the client's most recent menstrual period. Drives sample-collection timing — per A/641 Op.Inst. 5.1 section 10, samples should not be collected during heavy menstrual flow. #xD; currentlyPregnant 0..1 boolean Whether the client is currently pregnant. Pregnant women in the first 3 months may be opportunistically included in screening per A/641 section 2.2. #xD; gestationalAgeWeeks 0..1 integer If currently pregnant, gestational age in weeks. Required if currentlyPregnant = true. #xD; currentContraception 0..1 string Description of the client's current contraception method (free text; will bind to a contraception-method valueset when smart-core's medicationstatement-current-contraceptive-methods profile is vendored) #xD; pastContraception 0..1 string Description of past contraception methods used (free text) #xD; ageAtFirstSexualContact 0..1 integer Client's age in years at first sexual contact. Risk factor — earlier age is associated with higher cervical cancer risk. #xD; ageAtFirstDelivery 0..1 integer Client's age in years at first delivery (if any). Risk factor. #xD; numberOfSexualPartners 0..1 integer Lifetime number of sexual partners. Risk factor. #xD; hasHadSTI 0..1 boolean Whether the client has had any sexually transmitted infection. Risk factor. #xD; hivStatus 0..1 Coding Client's HIV status. Bound to CXCA.D codes DE17 (HIV-positive), DE18 (HIV-negative), DE19 (HIV status unknown). Per WHO, WLHIV are 6× more likely to develop cervical cancer. #xD; currentlyOnART 0..1 boolean If HIV-positive, whether the client is currently on antiretroviral therapy. Required (per FHIRPath invariant) when hivStatus indicates HIV-positive. #xD; lastScreeningDate 0..1 date Date of the client's most recent prior cervical cancer screening, if any. Drives the recall-cycle / not-due-in-cycle decision. #xD; lastScreeningType 0..1 Coding Type of the most recent prior screening. Bound to CXCA.D codes DE23 (HPV), DE24 (cytology), DE25 (VIA). #xD; lastScreeningResult 0..1 Coding Result category of the most recent prior screening. Bound to CXCA.D codes DE26 (normal), DE27 (abnormal), DE28 (unknown). #xD; hadHysterectomy 0..1 boolean Whether the client has had a hysterectomy. Drives the eligibility-exclusion check per A/641 section 2.2. #xD; hysterectomyForCervicalCancer 0..1 boolean If hadHysterectomy = true, whether the indication was cervical cancer (in which case the screening exclusion does NOT apply per A/641 section 2.2). Required when hadHysterectomy = true. #xD; smokingStatus 0..1 Coding Client's smoking status. Bound to CXCA.D codes DE20 (current), DE21 (former), DE22 (never). #xD; alcoholUse 0..1 boolean Whether the client consumes alcohol regularly. Documented as a risk factor per A/641 section 1.3.2. #xD; hasPostcoitalBleeding 0..1 boolean Whether the client reports bleeding after intercourse. May indicate cervical pathology — flag for clinician attention. #xD; hasIntermenstrualBleeding 0..1 boolean Whether the client reports bleeding between menstrual periods. May indicate cervical pathology. #xD; hasUnusualDischarge 0..1 boolean Whether the client reports unusual vaginal discharge. #xD; Documentation for this format
CXCA.D1 — Cervical Cancer Screening Anamnesis
Logical model for the first-encounter intake / anamnesis used at the start of a cervical cancer screening encounter. Mirrors A/641 (2020) Op.Inst. 5.1 (p. 105). Paired with QCXCAD1 Questionnaire for data capture; the eventual SDC StructureMap will extract a filled-in QuestionnaireResponse into FHIR resources conforming to vendored smart-core profiles.
If currentlyPregnant = true, gestationalAgeWeeks must be provided
currentlyPregnant.empty() or currentlyPregnant = false or gestationalAgeWeeks.exists()
If hivStatus indicates HIV-positive (CXCA.D#DE17), currentlyOnART must be provided
hivStatus.empty() or hivStatus.code != 'DE17' or currentlyOnART.exists()
If hadHysterectomy = true, hysterectomyForCervicalCancer must be provided
hadHysterectomy.empty() or hadHysterectomy = false or hysterectomyForCervicalCancer.exists()
Last screening date cannot be in the future
lastScreeningDate.empty() or lastScreeningDate <= today()
Client's age in years on the encounter date
Client's highest level of education completed (free text in this iteration; may be coded against an ISCED valueset in a future iteration)
Number of pregnancies (gravidity), regardless of outcome
First day of the client's most recent menstrual period. Drives sample-collection timing — per A/641 Op.Inst. 5.1 section 10, samples should not be collected during heavy menstrual flow.
Whether the client is currently pregnant. Pregnant women in the first 3 months may be opportunistically included in screening per A/641 section 2.2.
If currently pregnant, gestational age in weeks. Required if currentlyPregnant = true.
Description of the client's current contraception method (free text; will bind to a contraception-method valueset when smart-core's medicationstatement-current-contraceptive-methods profile is vendored)
Description of past contraception methods used (free text)
Client's age in years at first sexual contact. Risk factor — earlier age is associated with higher cervical cancer risk.
Client's age in years at first delivery (if any). Risk factor.
Lifetime number of sexual partners. Risk factor.
Whether the client has had any sexually transmitted infection. Risk factor.
Client's HIV status. Bound to CXCA.D codes DE17 (HIV-positive), DE18 (HIV-negative), DE19 (HIV status unknown). Per WHO, WLHIV are 6× more likely to develop cervical cancer.
If HIV-positive, whether the client is currently on antiretroviral therapy. Required (per FHIRPath invariant) when hivStatus indicates HIV-positive.
Date of the client's most recent prior cervical cancer screening, if any. Drives the recall-cycle / not-due-in-cycle decision.
Type of the most recent prior screening. Bound to CXCA.D codes DE23 (HPV), DE24 (cytology), DE25 (VIA).
Result category of the most recent prior screening. Bound to CXCA.D codes DE26 (normal), DE27 (abnormal), DE28 (unknown).
Whether the client has had a hysterectomy. Drives the eligibility-exclusion check per A/641 section 2.2.
If hadHysterectomy = true, whether the indication was cervical cancer (in which case the screening exclusion does NOT apply per A/641 section 2.2). Required when hadHysterectomy = true.
Client's smoking status. Bound to CXCA.D codes DE20 (current), DE21 (former), DE22 (never).
Whether the client consumes alcohol regularly. Documented as a risk factor per A/641 section 1.3.2.
Whether the client reports bleeding after intercourse. May indicate cervical pathology — flag for clinician attention.
Whether the client reports bleeding between menstrual periods. May indicate cervical pathology.
Whether the client reports unusual vaginal discharge.