| Package | smart.who.int.hiv |
| Resource Type | Questionnaire |
| Id | HIV.C23PrescribeOrAdministerPrepOrPep |
| FHIR Version | R4 |
| Source | http://smart.who.int/hiv/https://build.fhir.org/ig/WorldHealthOrganization/smart-hiv/Questionnaire-HIV.C23PrescribeOrAdministerPrepOrPep.html |
| URL | http://smart.who.int/hiv/Questionnaire/HIV.C23PrescribeOrAdministerPrepOrPep |
| Version | 0.4.4 |
| Status | draft |
| Date | 2025-07-24T19:24:35+00:00 |
| Title | Prescribe or administer PrEP or PEP |
| Authority | who |
| Description | Questionnaire for prescribe or administer PrEP or PEP |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire HIV.C23PrescribeOrAdministerPrepOrPep
Language: en
Profiles: Extractable Questionnaire - StructureMap, CRMI Shareable Questionnaire, CRMI Publishable Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
  | Questionnaire for prescribe or administer PrEP or PEP | Questionnaire | http://smart.who.int/hiv/Questionnaire/HIV.C23PrescribeOrAdministerPrepOrPep#0.4.4 | ||
  HIV.C.DE73 | Date medications dispensed | 0..1 | date | ||
| HIV.C.DE74 | Date medications prescribed | 0..1 | date | ||
 HIV.C.DE75 | Medications prescribed | 0..1 | choice | Value Set: #HIV.C.DE75 | |
 HIV.C.DE79 | Other (specify) | 0..1 | string | ||
| HIV.C.DE80 | PrEP product prescribed | 0..1 | choice | Value Set: #HIV.C.DE80 | |
| HIV.C.DE85 | Other (specify) | 0..1 | string | ||
| HIV.C.DE86 | Date PrEP prescribed | 0..1 | date | ||
| HIV.C.DE87 | Date PrEP dispensed | 0..1 | date | ||
 HIV.C.DE88 | Volume of PrEP product prescribed/dispensed | 0..1 | integer | ||
| HIV.C.DE89 | Date PEP prescribed | 0..1 | date | ||
| HIV.C.DE90 | Date PEP course completion | 0..1 | date | ||
| HIV.C.DE91 | Preferred PEP backbone regimen | 0..1 | choice | Value Set: #HIV.C.DE91 | |
| HIV.C.DE99 | Preferred third PEP drug | 0..1 | choice | Value Set: #HIV.C.DE99 | |
| HIV.C.DE106 | Estimated creatinine clearance | 0..1 | integer | ||
| HIV.C.DE107 | Sex factor for estimating creatinine clearance | 0..1 | choice | Value Set: #HIV.C.DE107 | |
| HIV.C.DE110 | Estimated creatinine clearance (Cockcroft–Gault equation) | 0..1 | integer | ||
 HIV.C.DE111 | Date of sample collection | 0..1 | dateTime | ||
| HIV.C.DE112 | Contraindications to PrEP usage | 0..1 | choice | Value Set: #HIV.C.DE112 | |
| HIV.C.DE119 | Other allergy or contraindication to a medicine in the PrEP regimen (specify) | 0..1 | string | ||
 HIV.C.DE120 | Prescribed PrEP at initial visit | 0..1 | boolean | ||
| HIV.C.DE121 | Number of days prescribed | 0..1 | integer | ||
| HIV.C.DE122 | PrEP regimen prescribed | 0..1 | choice | Value Set: #HIV.C.DE122 | |
 HIV.C.DE123 | Adherence counselling provided | 0..1 | boolean | ||
| Documentation for this format | |||||
FHIR{
"resourceType": "Questionnaire",
"id": "HIV.C23PrescribeOrAdministerPrepOrPep",
"meta": {
"profile": [
"http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap",
"http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablequestionnaire",
"http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-publishablequestionnaire"
]
},
"language": "en",
"text": {
"status": "extensions",
"div": "<!-- snip (see above) -->"
},
"url": "http://smart.who.int/hiv/Questionnaire/HIV.C23PrescribeOrAdministerPrepOrPep",
"version": "0.4.4",
"title": "Prescribe or administer PrEP or PEP",
"status": "draft",
"experimental": true,
"subjectType": [
"Patient"
],
"date": "2025-07-24T19:24:35+00:00",
"publisher": "WHO",
"contact": [
{
"name": "WHO",
"telecom": [
{
"system": "url",
"value": "http://who.int"
}
]
}
],
"description": "Questionnaire for prescribe or administer PrEP or PEP",
"item": [
{
"id": "HIV.C.DE73",
"linkId": "HIV.C.DE73",
"text": "Date medications dispensed",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE74",
"linkId": "HIV.C.DE74",
"text": "Date medications prescribed",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE75",
"linkId": "HIV.C.DE75",
"text": "Medications prescribed",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.C.DE75"
},
{
"id": "HIV.C.DE79",
"linkId": "HIV.C.DE79",
"text": "Other (specify)",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE80",
"linkId": "HIV.C.DE80",
"text": "PrEP product prescribed",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.C.DE80"
},
{
"id": "HIV.C.DE85",
"linkId": "HIV.C.DE85",
"text": "Other (specify)",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE86",
"linkId": "HIV.C.DE86",
"text": "Date PrEP prescribed",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE87",
"linkId": "HIV.C.DE87",
"text": "Date PrEP dispensed",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE88",
"linkId": "HIV.C.DE88",
"text": "Volume of PrEP product prescribed/dispensed",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE89",
"linkId": "HIV.C.DE89",
"text": "Date PEP prescribed",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE90",
"linkId": "HIV.C.DE90",
"text": "Date PEP course completion",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE91",
"linkId": "HIV.C.DE91",
"text": "Preferred PEP backbone regimen",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.C.DE91"
},
{
"id": "HIV.C.DE99",
"linkId": "HIV.C.DE99",
"text": "Preferred third PEP drug",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.C.DE99"
},
{
"id": "HIV.C.DE106",
"linkId": "HIV.C.DE106",
"text": "Estimated creatinine clearance",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE107",
"linkId": "HIV.C.DE107",
"text": "Sex factor for estimating creatinine clearance",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.C.DE107"
},
{
"id": "HIV.C.DE110",
"linkId": "HIV.C.DE110",
"text": "Estimated creatinine clearance (Cockcroft–Gault equation)",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE111",
"linkId": "HIV.C.DE111",
"text": "Date of sample collection",
"type": "dateTime",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE112",
"linkId": "HIV.C.DE112",
"text": "Contraindications to PrEP usage",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.C.DE112"
},
{
"id": "HIV.C.DE119",
"linkId": "HIV.C.DE119",
"text": "Other allergy or contraindication to a medicine in the PrEP regimen (specify)",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE120",
"linkId": "HIV.C.DE120",
"text": "Prescribed PrEP at initial visit",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE121",
"linkId": "HIV.C.DE121",
"text": "Number of days prescribed",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.C.DE122",
"linkId": "HIV.C.DE122",
"text": "PrEP regimen prescribed",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.C.DE122"
},
{
"id": "HIV.C.DE123",
"linkId": "HIV.C.DE123",
"text": "Adherence counselling provided",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
}
]
}