FHIR IG analytics| Package | smart.who.int.cxca |
| Resource Type | CodeSystem |
| Id | CodeSystem-CXCA.D.json |
| FHIR Version | R4 |
| Source | https://build.fhir.org/ig/dhes/smart-dak-cxca/CodeSystem-CXCA.D.html |
| URL | http://smart.who.int/cxca/CodeSystem/CXCA.D |
| Version | 0.0.1 |
| Status | draft |
| Date | 2026-05-14T00:50:23+00:00 |
| Name | CXCA_D |
| Title | CXCA Data Dictionary |
| Description | 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. |
| Content | complete |
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Note: links and images are rebased to the (stated) source
Generated Narrative: CodeSystem CXCA.D
This case-sensitive code system http://smart.who.int/cxca/CodeSystem/CXCA.D defines the following codes:
FHIR
FHIRsmith{
"resourceType": "CodeSystem",
"id": "CXCA.D",
"text": {
"status": "generated",
"div": "<!-- snip (see above) -->"
},
"url": "http://smart.who.int/cxca/CodeSystem/CXCA.D",
"version": "0.0.1",
"name": "CXCA_D",
"title": "CXCA Data Dictionary",
"status": "draft",
"experimental": false,
"date": "2026-05-14T00:50:23+00:00",
"publisher": "Dan Heslinga (independent contributor)",
"contact": [
{
"name": "Dan Heslinga (independent contributor)",
"telecom": [
{
"system": "url",
"value": "https://github.com/dhes"
}
]
}
],
"description": "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": true,
"content": "complete",
"count": 40,
"concept": [
{
"code": "DE1",
"display": "Target age 35 for HPV screening",
"definition": "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)."
},
{
"code": "DE2",
"display": "Target age 45 for HPV screening",
"definition": "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)."
},
{
"code": "DE3",
"display": "HPV high-risk DNA test",
"definition": "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."
},
{
"code": "DE4",
"display": "Due for HPV screening",
"definition": "Eligibility outcome: the client meets the criteria to be offered HPV high-risk DNA screening at this encounter."
},
{
"code": "DE5",
"display": "Not due — already screened in current cycle",
"definition": "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."
},
{
"code": "DE6",
"display": "Excluded — outside target age range",
"definition": "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."
},
{
"code": "DE7",
"display": "Excluded — prior hysterectomy",
"definition": "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."
},
{
"code": "DE8",
"display": "HPV high-risk positive",
"definition": "Result: at least one high-risk human papillomavirus genotype detected in the cervical sample."
},
{
"code": "DE9",
"display": "HPV high-risk negative",
"definition": "Result: no high-risk human papillomavirus genotypes detected in the cervical sample."
},
{
"code": "DE10",
"display": "Lost to follow-up",
"definition": "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."
},
{
"code": "DE13",
"display": "Cervical cytology test",
"definition": "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)."
},
{
"code": "DE17",
"display": "HIV-positive",
"definition": "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."
},
{
"code": "DE18",
"display": "HIV-negative",
"definition": "Client has a documented negative HIV test."
},
{
"code": "DE19",
"display": "HIV status unknown",
"definition": "Client's HIV status has not been documented. May warrant offering HIV testing alongside cervical cancer screening."
},
{
"code": "DE20",
"display": "Current smoker",
"definition": "Client currently smokes tobacco (any amount, any form)."
},
{
"code": "DE21",
"display": "Former smoker",
"definition": "Client has smoked tobacco in the past but has quit."
},
{
"code": "DE22",
"display": "Never smoker",
"definition": "Client has never smoked tobacco."
},
{
"code": "DE23",
"display": "Past screening: HPV high-risk DNA test",
"definition": "Client's most recent prior cervical cancer screening was an HPV high-risk DNA test."
},
{
"code": "DE24",
"display": "Past screening: cytology only",
"definition": "Client's most recent prior cervical cancer screening was cytology (Pap smear) only."
},
{
"code": "DE25",
"display": "Past screening: VIA (visual inspection with acetic acid)",
"definition": "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."
},
{
"code": "DE26",
"display": "Past screening: normal / negative",
"definition": "Client's most recent prior screening result was normal / negative for cervical pre-cancer or cancer."
},
{
"code": "DE27",
"display": "Past screening: abnormal / positive",
"definition": "Client's most recent prior screening result was abnormal / positive (any abnormality — finer classification not captured at this level)."
},
{
"code": "DE28",
"display": "Past screening: result unknown",
"definition": "Client recalls having been screened but cannot recall the result, or the result is not in available records."
},
{
"code": "DE29",
"display": "Cytology: NILM (negative for intraepithelial lesion or malignancy)",
"definition": "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."
},
{
"code": "DE30",
"display": "Cytology: ASC-US (atypical squamous cells of undetermined significance)",
"definition": "Bethesda 2014 ASC-US. Atypical squamous cells of undetermined significance. Triggers colposcopy referral in the HPV+ pathway per A/641 Fig 2.4."
},
{
"code": "DE31",
"display": "Cytology: ASC-H (atypical squamous cells, cannot exclude HSIL)",
"definition": "Bethesda 2014 ASC-H. Atypical squamous cells where high-grade squamous intraepithelial lesion (HSIL) cannot be excluded. Triggers colposcopy referral."
},
{
"code": "DE32",
"display": "Cytology: LSIL (low-grade squamous intraepithelial lesion)",
"definition": "Bethesda 2014 LSIL. Low-grade squamous intraepithelial lesion (corresponds to histologic CIN1). Triggers colposcopy referral in the HPV+ pathway."
},
{
"code": "DE33",
"display": "Cytology: HSIL (high-grade squamous intraepithelial lesion)",
"definition": "Bethesda 2014 HSIL. High-grade squamous intraepithelial lesion (corresponds to histologic CIN2 or CIN3). Triggers colposcopy referral with priority."
},
{
"code": "DE34",
"display": "Route: return to routine screening",
"definition": "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)."
},
{
"code": "DE35",
"display": "Route: repeat HPV test in 12 months",
"definition": "Routing decision output: HPV+ with negative cytology re-read; repeat the HPV test in 12 months per A/641 Fig 2.4."
},
{
"code": "DE36",
"display": "Route: refer to colposcopy",
"definition": "Routing decision output: HPV+ with cytology ≥ ASC-US, OR HPV+ at 12-month recheck; refer to colposcopy per Op.Inst. 5.6."
},
{
"code": "DE37",
"display": "Colposcopy",
"definition": "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."
},
{
"code": "DE38",
"display": "Recall: HPV sample result timeout (3 weeks)",
"definition": "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."
},
{
"code": "DE39",
"display": "Recall: positive result follow-up timeout (4 weeks)",
"definition": "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."
},
{
"code": "DE40",
"display": "Recall: biopsy result timeout (4 weeks)",
"definition": "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."
},
{
"code": "DE41",
"display": "Recall: treatment timeout after positive biopsy (4 weeks)",
"definition": "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."
},
{
"code": "DE42",
"display": "Recall: cytology slide unread timeout (2 weeks)",
"definition": "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."
},
{
"code": "DE43",
"display": "Recall: second reminder (4 weeks after first)",
"definition": "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."
},
{
"code": "DE44",
"display": "Recall: missed scheduled examination",
"definition": "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."
},
{
"code": "DE45",
"display": "Hysterectomy",
"definition": "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."
}
]
}