Generated Narrative: Questionnaire HIV.D21DetermineRegimenAndTreatmentOptions Language: en Profiles: Extractable Questionnaire - StructureMap, CRMI Shareable Questionnaire, CRMI Publishable Questionnaire LinkID Text Cardinality Type Flags Description & Constraints Questionnaire for determine regimen and treatment options Questionnaire http://smart.who.int/hiv/Questionnaire/HIV.D21DetermineRegimenAndTreatmentOptions#0.4.4 #xD; HIV.D.DE418 Reason for ARV drug regimen substitution 0..1 choice Value Set: #HIV.D.DE418 #xD; HIV.D.DE426 Other reason for regimen substitution (specify) 0..1 string #xD; HIV.D.DE427 Switch to second-line ART regimen recommended 0..1 boolean #xD; HIV.D.DE428 Switch to third-line ART regimen recommended 0..1 boolean #xD; HIV.D.DE466 Type of treatment-limiting toxicity 0..1 choice Value Set: #HIV.D.DE466 #xD; HIV.D.DE480 Unexpected adverse drug reaction (specify) 0..1 string #xD; HIV.D.DE481 Date(s) of substitution within first-line regimen 0..1 date #xD; HIV.D.DE482 Reason(s) for substitution within first-line regimen 0..1 choice Value Set: #HIV.D.DE482 #xD; HIV.D.DE483 New antiretroviral regimen after substitution within first-line regimen 0..1 choice Value Set: #HIV.D.DE483 #xD; HIV.D.DE484 Date of switch to second-line regimen 0..1 date #xD; HIV.D.DE485 New regimen after switch to second-line regimen 0..1 choice Value Set: #HIV.D.DE485 #xD; HIV.D.DE486 Reason for switch to second-line regimen 0..1 choice Value Set: #HIV.D.DE486 #xD; HIV.D.DE487 Date(s) of substitution within second-line regimen 0..1 date #xD; HIV.D.DE488 Reason(s) for substitution within second-line regimen 0..1 choice Value Set: #HIV.D.DE488 #xD; HIV.D.DE489 New regimen(s) after substitution within second-line regimen 0..1 choice Value Set: #HIV.D.DE489 #xD; HIV.D.DE490 Date of switch to third-line regimen 0..1 date #xD; HIV.D.DE491 New regimen after switch to third-line regimen 0..1 choice Value Set: #HIV.D.DE491 #xD; HIV.D.DE492 Reason for switch to third-line regimen 0..1 choice Value Set: #HIV.D.DE492 #xD; HIV.D.DE493 Date(s) of substitution within third-line regimen 0..1 date #xD; HIV.D.DE494 Reason(s) for substitution within third-line regimen 0..1 choice Value Set: #HIV.D.DE494 #xD; HIV.D.DE495 New regimen(s) after substitution within third-line regimen 0..1 choice Value Set: #HIV.D.DE495 #xD; HIV.D.DE643 Malaria prophylaxis 1..1 boolean #xD; HIV.D.DE644 IPTp-SP dose number provided 1..1 integer #xD; HIV.D.DE645 Date IPTp-SP dose provided 0..1 date #xD; HIV.D.DE646 Reason malaria prophylaxis not provided 0..1 choice Value Set: #HIV.D.DE646 #xD; HIV.D.DE651 Other reason not provided (specify) 0..1 string #xD; HIV.D.DE652 >28 days since last missed appointment 0..1 boolean #xD; HIV.D.DE760 Eligible for DSD ART 0..1 boolean #xD; HIV.D.DE761 Date DSD ART eligibility assessed 0..1 date #xD; HIV.D.DE762 Currently enrolled in DSD ART model 0..1 boolean #xD; HIV.D.DE763 DSD ART start date 0..1 date #xD; HIV.D.DE764 DSD ART model(s) 0..1 choice Value Set: #HIV.D.DE764 #xD; HIV.D.DE771 Other DSD ART model (specify) 0..1 string #xD; HIV.D.DE903 Medication/drug 0..1 choice Value Set: #HIV.D.DE903 #xD; HIV.D.DE932 Other (specify) 0..1 string #xD; HIV.D.DE933 Medication change recommended 0..1 boolean #xD; HIV.D.DE1023 TB prevention services accepted 0..1 boolean #xD; Documentation for this format
Questionnaire for determine regimen and treatment options
Reason for ARV drug regimen substitution
Other reason for regimen substitution (specify)
Switch to second-line ART regimen recommended
Switch to third-line ART regimen recommended
Unexpected adverse drug reaction (specify)
Date(s) of substitution within first-line regimen
Reason(s) for substitution within first-line regimen
New antiretroviral regimen after substitution within first-line regimen
New regimen after switch to second-line regimen
Reason for switch to second-line regimen
Date(s) of substitution within second-line regimen
Reason(s) for substitution within second-line regimen
New regimen(s) after substitution within second-line regimen
New regimen after switch to third-line regimen
Date(s) of substitution within third-line regimen
Reason(s) for substitution within third-line regimen
New regimen(s) after substitution within third-line regimen