Generated Narrative: Questionnaire HIV.D8CaptureOrUpdateClientHistory Language: en Profiles: Extractable Questionnaire - StructureMap, CRMI Shareable Questionnaire, CRMI Publishable Questionnaire LinkID Text Cardinality Type Flags Description & Constraints Questionnaire for capture or update client history Questionnaire http://smart.who.int/hiv/Questionnaire/HIV.D8CaptureOrUpdateClientHistory#0.4.4 #xD; HIV.D.DE31 Currently pregnant 0..1 boolean #xD; HIV.D.DE32 Breastfeeding 0..1 boolean #xD; HIV.D.DE33 Number of pregnancies (gravida) 0..1 integer #xD; HIV.D.DE34 Number of miscarriages and/or abortions 0..1 integer #xD; HIV.D.DE35 Number of live births 0..1 integer #xD; HIV.D.DE36 Parity 0..1 integer #xD; HIV.D.DE37 Serodiscordant partner 0..1 boolean #xD; HIV.D.DE38 On ART 1..1 boolean #xD; HIV.D.DE39 ART start date 0..1 date #xD; HIV.D.DE40 Stopped ART 0..1 boolean #xD; HIV.D.DE41 Date ART stopped 0..1 date #xD; HIV.D.DE42 Established on ART 0..1 boolean #xD; HIV.D.DE43 ART start type 0..1 choice Value Set: #HIV.D.DE43 #xD; HIV.D.DE46 Date of initiation on ART 0..1 date #xD; HIV.D.DE47 Time on ART 0..1 integer #xD; HIV.D.DE48 Date(s) ART restarted 0..1 date #xD; HIV.D.DE49 ART cohort 0..1 date #xD; HIV.D.DE50 Transfer in for HIV care 0..1 boolean #xD; HIV.D.DE51 Date of transfer in 0..1 date #xD; HIV.D.DE52 Facility transferred from 0..1 choice Value Set: #HIV.D.DE52 #xD; HIV.D.DE53 Date enrolled in HIV care 0..1 date #xD; HIV.D.DE54 Age at enrolment 0..1 integer #xD; HIV.D.DE55 Facility where client first enrolled in HIV care 0..1 choice Value Set: #HIV.D.DE55 #xD; HIV.D.DE56 Antiretroviral (ARV) drugs received prior to enrolment 0..1 choice Value Set: #HIV.D.DE56 #xD; HIV.D.DE62 Date ARV drugs received prior to enrolment 0..1 date #xD; HIV.D.DE63 Location ARV drugs received prior to enrolment 0..1 choice Value Set: #HIV.D.DE63 #xD; HIV.D.DE64 ARV drug regimen received prior to enrolment 0..1 choice Value Set: #HIV.D.DE64 #xD; HIV.D.DE65 Existing chronic health conditions 0..1 choice Value Set: #HIV.D.DE65 #xD; HIV.D.DE73 Other (specify) 0..1 string #xD; HIV.D.DE74 Original first-line ART regimen 0..1 choice Value Set: #HIV.D.DE74 #xD; HIV.D.DE75 Current ART regimen 0..1 choice Value Set: #HIV.D.DE75 #xD; HIV.D.DE76 Current ART regimen start date 0..1 date #xD; HIV.D.DE77 Preferred first-line ART regimen 0..1 choice Value Set: #HIV.D.DE77 #xD; HIV.D.DE78 Alternative first-line ART regimen 0..1 choice Value Set: #HIV.D.DE78 #xD; HIV.D.DE79 First-line ART regimen under special circumstances 0..1 choice Value Set: #HIV.D.DE79 #xD; HIV.D.DE80 Preferred second-line ART regimen 0..1 choice Value Set: #HIV.D.DE80 #xD; HIV.D.DE81 Alternative second-line ART regimen 0..1 choice Value Set: #HIV.D.DE81 #xD; HIV.D.DE82 Optimal regimen for transition 0..1 choice Value Set: #HIV.D.DE82 #xD; HIV.D.DE83 Current ART regimen (first-, second-, or third-line) 0..1 choice Value Set: #HIV.D.DE83 #xD; HIV.D.DE90 ART regimen 0..1 choice Value Set: #HIV.D.DE90 #xD; HIV.D.DE127 Other (specify) 0..1 string #xD; HIV.D.DE128 ART regimen composition 0..1 choice Value Set: #HIV.D.DE128 #xD; HIV.D.DE146 ART regimen drug class 0..1 choice Value Set: #HIV.D.DE146 #xD; HIV.D.DE186 HIV clinical stage 0..1 choice Value Set: #HIV.D.DE186 #xD; HIV.D.DE191 Number of missed doses 0..1 integer #xD; HIV.D.DE370 Reasons for delayed ART initiation 0..1 choice Value Set: #HIV.D.DE370 #xD; HIV.D.DE381 Other (specify) 0..1 string #xD; HIV.D.DE382 ART initiated within 7 days of diagnosis 0..1 boolean #xD; HIV.D.DE383 Time to start ART 0..1 choice Value Set: #HIV.D.DE383 #xD; HIV.D.DE456 Regimen start date 0..1 date #xD; HIV.D.DE537 Current medications 1..1 choice Value Set: #HIV.D.DE537 #xD; HIV.D.DE559 Other medications (specify) 0..1 string #xD; HIV.D.DE560 Allergies 1..1 choice Value Set: #HIV.D.DE560 #xD; HIV.D.DE568 Other allergies (specify) 0..1 string #xD; HIV.D.DE569 Family planning method used 0..1 choice Value Set: #HIV.D.DE569 #xD; HIV.D.DE593 Medication status 0..1 choice Value Set: #HIV.D.DE593 #xD; HIV.D.DE653 AIDS-related death 0..1 boolean #xD; HIV.D.DE654 Date of first AIDS diagnosis 0..1 date #xD; HIV.D.DE655 Age at final HPV vaccination dose received 0..1 integer #xD; HIV.D.DE938 TB disease 0..1 boolean #xD; HIV.D.DE939 TB diagnosis result 0..1 choice Value Set: #HIV.D.DE939 #xD; HIV.D.DE942 Method of TB diagnosis 0..1 choice Value Set: #HIV.D.DE942 #xD; HIV.D.DE945 Presumptive TB 0..1 boolean #xD; HIV.D.DE946 Presumptive TB registration date 0..1 date #xD; HIV.D.DE947 TB treatment history 0..1 choice Value Set: #HIV.D.DE947 #xD; HIV.D.DE952 Date of TB diagnosis 0..1 date #xD; HIV.D.DE953 Currently on TB preventive treatment (TPT) 1..1 boolean #xD; HIV.D.DE954 TB preventive treatment (TPT) start date 0..1 date #xD; HIV.D.DE955 TB preventive treatment (TPT) completion date 0..1 date #xD; HIV.D.DE1000 TB treatment started 0..1 boolean #xD; HIV.D.DE1001 TB treatment start date 0..1 date #xD; HIV.D.DE1002 TB treatment outcome 0..1 choice Value Set: #HIV.D.DE1002 #xD; HIV.D.DE1009 TB treatment completion date 0..1 date #xD; HIV.D.DE1010 TB treatment regimen composition 0..1 choice Value Set: #HIV.D.DE1010 #xD; Documentation for this format
Questionnaire for capture or update client history
Facility where client first enrolled in HIV care
Antiretroviral (ARV) drugs received prior to enrolment
Date ARV drugs received prior to enrolment
Location ARV drugs received prior to enrolment
ARV drug regimen received prior to enrolment
First-line ART regimen under special circumstances
Current ART regimen (first-, second-, or third-line)
ART initiated within 7 days of diagnosis
Age at final HPV vaccination dose received
Currently on TB preventive treatment (TPT)
TB preventive treatment (TPT) start date
TB preventive treatment (TPT) completion date