Package | smart.who.int.hiv |
Resource Type | Questionnaire |
Id | HIV.D8CaptureOrUpdateClientHistory |
FHIR Version | R4 |
Source | http://smart.who.int/hiv/https://build.fhir.org/ig/WorldHealthOrganization/smart-hiv/Questionnaire-HIV.D8CaptureOrUpdateClientHistory.html |
URL | http://smart.who.int/hiv/Questionnaire/HIV.D8CaptureOrUpdateClientHistory |
Version | 0.4.4 |
Status | draft |
Date | 2025-07-24T19:24:35+00:00 |
Title | Capture or update client history |
Authority | who |
Description | Questionnaire for capture or update client history |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
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 | ||
![]() ![]() ![]() | Currently pregnant | 0..1 | boolean | ||
![]() ![]() ![]() | Breastfeeding | 0..1 | boolean | ||
![]() ![]() ![]() | Number of pregnancies (gravida) | 0..1 | integer | ||
![]() ![]() ![]() | Number of miscarriages and/or abortions | 0..1 | integer | ||
![]() ![]() ![]() | Number of live births | 0..1 | integer | ||
![]() ![]() ![]() | Parity | 0..1 | integer | ||
![]() ![]() ![]() | Serodiscordant partner | 0..1 | boolean | ||
![]() ![]() ![]() | On ART | 1..1 | boolean | ||
![]() ![]() ![]() | ART start date | 0..1 | date | ||
![]() ![]() ![]() | Stopped ART | 0..1 | boolean | ||
![]() ![]() ![]() | Date ART stopped | 0..1 | date | ||
![]() ![]() ![]() | Established on ART | 0..1 | boolean | ||
![]() ![]() ![]() | ART start type | 0..1 | choice | Value Set: #HIV.D.DE43 | |
![]() ![]() ![]() | Date of initiation on ART | 0..1 | date | ||
![]() ![]() ![]() | Time on ART | 0..1 | integer | ||
![]() ![]() ![]() | Date(s) ART restarted | 0..1 | date | ||
![]() ![]() ![]() | ART cohort | 0..1 | date | ||
![]() ![]() ![]() | Transfer in for HIV care | 0..1 | boolean | ||
![]() ![]() ![]() | Date of transfer in | 0..1 | date | ||
![]() ![]() ![]() | Facility transferred from | 0..1 | choice | Value Set: #HIV.D.DE52 | |
![]() ![]() ![]() | Date enrolled in HIV care | 0..1 | date | ||
![]() ![]() ![]() | Age at enrolment | 0..1 | integer | ||
![]() ![]() ![]() | Facility where client first enrolled in HIV care | 0..1 | choice | Value Set: #HIV.D.DE55 | |
![]() ![]() ![]() | Antiretroviral (ARV) drugs received prior to enrolment | 0..1 | choice | Value Set: #HIV.D.DE56 | |
![]() ![]() ![]() | Date ARV drugs received prior to enrolment | 0..1 | date | ||
![]() ![]() ![]() | Location ARV drugs received prior to enrolment | 0..1 | choice | Value Set: #HIV.D.DE63 | |
![]() ![]() ![]() | ARV drug regimen received prior to enrolment | 0..1 | choice | Value Set: #HIV.D.DE64 | |
![]() ![]() ![]() | Existing chronic health conditions | 0..1 | choice | Value Set: #HIV.D.DE65 | |
![]() ![]() ![]() | Other (specify) | 0..1 | string | ||
![]() ![]() ![]() | Original first-line ART regimen | 0..1 | choice | Value Set: #HIV.D.DE74 | |
![]() ![]() ![]() | Current ART regimen | 0..1 | choice | Value Set: #HIV.D.DE75 | |
![]() ![]() ![]() | Current ART regimen start date | 0..1 | date | ||
![]() ![]() ![]() | Preferred first-line ART regimen | 0..1 | choice | Value Set: #HIV.D.DE77 | |
![]() ![]() ![]() | Alternative first-line ART regimen | 0..1 | choice | Value Set: #HIV.D.DE78 | |
![]() ![]() ![]() | First-line ART regimen under special circumstances | 0..1 | choice | Value Set: #HIV.D.DE79 | |
![]() ![]() ![]() | Preferred second-line ART regimen | 0..1 | choice | Value Set: #HIV.D.DE80 | |
![]() ![]() ![]() | Alternative second-line ART regimen | 0..1 | choice | Value Set: #HIV.D.DE81 | |
![]() ![]() ![]() | Optimal regimen for transition | 0..1 | choice | Value Set: #HIV.D.DE82 | |
![]() ![]() ![]() | Current ART regimen (first-, second-, or third-line) | 0..1 | choice | Value Set: #HIV.D.DE83 | |
![]() ![]() ![]() | ART regimen | 0..1 | choice | Value Set: #HIV.D.DE90 | |
![]() ![]() ![]() | Other (specify) | 0..1 | string | ||
![]() ![]() ![]() | ART regimen composition | 0..1 | choice | Value Set: #HIV.D.DE128 | |
![]() ![]() ![]() | ART regimen drug class | 0..1 | choice | Value Set: #HIV.D.DE146 | |
![]() ![]() ![]() | HIV clinical stage | 0..1 | choice | Value Set: #HIV.D.DE186 | |
![]() ![]() ![]() | Number of missed doses | 0..1 | integer | ||
![]() ![]() ![]() | Reasons for delayed ART initiation | 0..1 | choice | Value Set: #HIV.D.DE370 | |
![]() ![]() ![]() | Other (specify) | 0..1 | string | ||
![]() ![]() ![]() | ART initiated within 7 days of diagnosis | 0..1 | boolean | ||
![]() ![]() ![]() | Time to start ART | 0..1 | choice | Value Set: #HIV.D.DE383 | |
![]() ![]() ![]() | Regimen start date | 0..1 | date | ||
![]() ![]() ![]() | Current medications | 1..1 | choice | Value Set: #HIV.D.DE537 | |
![]() ![]() ![]() | Other medications (specify) | 0..1 | string | ||
![]() ![]() ![]() | Allergies | 1..1 | choice | Value Set: #HIV.D.DE560 | |
![]() ![]() ![]() | Other allergies (specify) | 0..1 | string | ||
![]() ![]() ![]() | Family planning method used | 0..1 | choice | Value Set: #HIV.D.DE569 | |
![]() ![]() ![]() | Medication status | 0..1 | choice | Value Set: #HIV.D.DE593 | |
![]() ![]() ![]() | AIDS-related death | 0..1 | boolean | ||
![]() ![]() ![]() | Date of first AIDS diagnosis | 0..1 | date | ||
![]() ![]() ![]() | Age at final HPV vaccination dose received | 0..1 | integer | ||
![]() ![]() ![]() | TB disease | 0..1 | boolean | ||
![]() ![]() ![]() | TB diagnosis result | 0..1 | choice | Value Set: #HIV.D.DE939 | |
![]() ![]() ![]() | Method of TB diagnosis | 0..1 | choice | Value Set: #HIV.D.DE942 | |
![]() ![]() ![]() | Presumptive TB | 0..1 | boolean | ||
![]() ![]() ![]() | Presumptive TB registration date | 0..1 | date | ||
![]() ![]() ![]() | TB treatment history | 0..1 | choice | Value Set: #HIV.D.DE947 | |
![]() ![]() ![]() | Date of TB diagnosis | 0..1 | date | ||
![]() ![]() ![]() | Currently on TB preventive treatment (TPT) | 1..1 | boolean | ||
![]() ![]() ![]() | TB preventive treatment (TPT) start date | 0..1 | date | ||
![]() ![]() ![]() | TB preventive treatment (TPT) completion date | 0..1 | date | ||
![]() ![]() ![]() | TB treatment started | 0..1 | boolean | ||
![]() ![]() ![]() | TB treatment start date | 0..1 | date | ||
![]() ![]() ![]() | TB treatment outcome | 0..1 | choice | Value Set: #HIV.D.DE1002 | |
![]() ![]() ![]() | TB treatment completion date | 0..1 | date | ||
![]() ![]() ![]() | TB treatment regimen composition | 0..1 | choice | Value Set: #HIV.D.DE1010 | |
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"repeats": false, "readOnly": false }, { "id": "HIV.D.DE32", "linkId": "HIV.D.DE32", "text": "Breastfeeding", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE33", "linkId": "HIV.D.DE33", "text": "Number of pregnancies (gravida)", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE34", "linkId": "HIV.D.DE34", "text": "Number of miscarriages and/or abortions", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE35", "linkId": "HIV.D.DE35", "text": "Number of live births", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE36", "linkId": "HIV.D.DE36", "text": "Parity", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE37", "linkId": "HIV.D.DE37", "text": "Serodiscordant partner", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE38", "linkId": "HIV.D.DE38", "text": "On ART", "type": "boolean", "required": true, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE39", "linkId": "HIV.D.DE39", "text": "ART start date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE40", "linkId": "HIV.D.DE40", "text": "Stopped ART", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE41", "linkId": "HIV.D.DE41", "text": "Date ART stopped", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE42", "linkId": "HIV.D.DE42", "text": "Established on ART", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE43", "linkId": "HIV.D.DE43", "text": "ART start type", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE43" }, { "id": "HIV.D.DE46", "linkId": "HIV.D.DE46", "text": "Date of initiation on ART", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE47", "linkId": "HIV.D.DE47", "text": "Time on ART", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE48", "linkId": "HIV.D.DE48", "text": "Date(s) ART restarted", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE49", "linkId": "HIV.D.DE49", "text": "ART cohort", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE50", "linkId": "HIV.D.DE50", "text": "Transfer in for HIV care", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE51", "linkId": "HIV.D.DE51", "text": "Date of transfer in", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE52", "linkId": "HIV.D.DE52", "text": "Facility transferred from", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE52" }, { "id": "HIV.D.DE53", "linkId": "HIV.D.DE53", "text": "Date enrolled in HIV care", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE54", "linkId": "HIV.D.DE54", "text": "Age at enrolment", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE55", "linkId": "HIV.D.DE55", "text": "Facility where client first enrolled in HIV care", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE55" }, { "id": "HIV.D.DE56", "linkId": "HIV.D.DE56", "text": "Antiretroviral (ARV) drugs received prior to enrolment", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE56" }, { "id": "HIV.D.DE62", "linkId": "HIV.D.DE62", "text": "Date ARV drugs received prior to enrolment", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE63", "linkId": "HIV.D.DE63", "text": "Location ARV drugs received prior to enrolment", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE63" }, { "id": "HIV.D.DE64", "linkId": "HIV.D.DE64", "text": "ARV drug regimen received prior to enrolment", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE64" }, { "id": "HIV.D.DE65", "linkId": "HIV.D.DE65", "text": "Existing chronic health conditions", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE65" }, { "id": "HIV.D.DE73", "linkId": "HIV.D.DE73", "text": "Other (specify)", "type": "string", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE74", "linkId": "HIV.D.DE74", "text": "Original first-line ART regimen", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE74" }, { "id": "HIV.D.DE75", "linkId": "HIV.D.DE75", "text": "Current ART regimen", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE75" }, { "id": "HIV.D.DE76", "linkId": "HIV.D.DE76", "text": "Current ART regimen start date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE77", "linkId": "HIV.D.DE77", "text": "Preferred first-line ART regimen", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE77" }, { "id": "HIV.D.DE78", "linkId": "HIV.D.DE78", "text": "Alternative first-line ART regimen", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE78" }, { "id": "HIV.D.DE79", "linkId": "HIV.D.DE79", "text": "First-line ART regimen under special circumstances", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE79" }, { "id": "HIV.D.DE80", "linkId": "HIV.D.DE80", "text": "Preferred second-line ART regimen", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE80" }, { "id": "HIV.D.DE81", "linkId": "HIV.D.DE81", "text": "Alternative second-line ART regimen", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE81" }, { "id": "HIV.D.DE82", "linkId": "HIV.D.DE82", "text": "Optimal regimen for transition", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE82" }, { "id": "HIV.D.DE83", "linkId": "HIV.D.DE83", "text": "Current ART regimen (first-, second-, or third-line)", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE83" }, { "id": "HIV.D.DE90", "linkId": "HIV.D.DE90", "text": "ART regimen", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE90" }, { "id": "HIV.D.DE127", "linkId": "HIV.D.DE127", "text": "Other (specify)", "type": "string", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE128", "linkId": "HIV.D.DE128", "text": "ART regimen composition", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE128" }, { "id": "HIV.D.DE146", "linkId": "HIV.D.DE146", "text": "ART regimen drug class", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE146" }, { "id": "HIV.D.DE186", "linkId": "HIV.D.DE186", "text": "HIV clinical stage", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE186" }, { "id": "HIV.D.DE191", "linkId": "HIV.D.DE191", "text": "Number of missed doses", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE370", "linkId": "HIV.D.DE370", "text": "Reasons for delayed ART initiation", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE370" }, { "id": "HIV.D.DE381", "linkId": "HIV.D.DE381", "text": "Other (specify)", "type": "string", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE382", "linkId": "HIV.D.DE382", "text": "ART initiated within 7 days of diagnosis", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE383", "linkId": "HIV.D.DE383", "text": "Time to start ART", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE383" }, { "id": "HIV.D.DE456", "linkId": "HIV.D.DE456", "text": "Regimen start date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE537", "linkId": "HIV.D.DE537", "text": "Current medications", "type": "choice", "required": true, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE537" }, { "id": "HIV.D.DE559", "linkId": "HIV.D.DE559", "text": "Other medications (specify)", "type": "string", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE560", "linkId": "HIV.D.DE560", "text": "Allergies", "type": "choice", "required": true, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE560" }, { "id": "HIV.D.DE568", "linkId": "HIV.D.DE568", "text": "Other allergies (specify)", "type": "string", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE569", "linkId": "HIV.D.DE569", "text": "Family planning method used", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE569" }, { "id": "HIV.D.DE593", "linkId": "HIV.D.DE593", "text": "Medication status", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE593" }, { "id": "HIV.D.DE653", "linkId": "HIV.D.DE653", "text": "AIDS-related death", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE654", "linkId": "HIV.D.DE654", "text": "Date of first AIDS diagnosis", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE655", "linkId": "HIV.D.DE655", "text": "Age at final HPV vaccination dose received", "type": "integer", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE938", "linkId": "HIV.D.DE938", "text": "TB disease", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE939", "linkId": "HIV.D.DE939", "text": "TB diagnosis result", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE939" }, { "id": "HIV.D.DE942", "linkId": "HIV.D.DE942", "text": "Method of TB diagnosis", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE942" }, { "id": "HIV.D.DE945", "linkId": "HIV.D.DE945", "text": "Presumptive TB", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE946", "linkId": "HIV.D.DE946", "text": "Presumptive TB registration date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE947", "linkId": "HIV.D.DE947", "text": "TB treatment history", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE947" }, { "id": "HIV.D.DE952", "linkId": "HIV.D.DE952", "text": "Date of TB diagnosis", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE953", "linkId": "HIV.D.DE953", "text": "Currently on TB preventive treatment (TPT)", "type": "boolean", "required": true, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE954", "linkId": "HIV.D.DE954", "text": "TB preventive treatment (TPT) start date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE955", "linkId": "HIV.D.DE955", "text": "TB preventive treatment (TPT) completion date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE1000", "linkId": "HIV.D.DE1000", "text": "TB treatment started", "type": "boolean", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE1001", "linkId": "HIV.D.DE1001", "text": "TB treatment start date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE1002", "linkId": "HIV.D.DE1002", "text": "TB treatment outcome", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE1002" }, { "id": "HIV.D.DE1009", "linkId": "HIV.D.DE1009", "text": "TB treatment completion date", "type": "date", "required": false, "repeats": false, "readOnly": false }, { "id": "HIV.D.DE1010", "linkId": "HIV.D.DE1010", "text": "TB treatment regimen composition", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.D.DE1010" } ] }