| Package | smart.who.int.hiv |
| Resource Type | Questionnaire |
| Id | HIV.E1CaptureOrUpdateMotherSHistory |
| FHIR Version | R4 |
| Source | http://smart.who.int/hiv/https://build.fhir.org/ig/WorldHealthOrganization/smart-hiv/Questionnaire-HIV.E1CaptureOrUpdateMotherSHistory.html |
| URL | http://smart.who.int/hiv/Questionnaire/HIV.E1CaptureOrUpdateMotherSHistory |
| Version | 0.4.4 |
| Status | draft |
| Date | 2025-07-24T19:24:35+00:00 |
| Title | Capture or update mother's history |
| Authority | who |
| Description | Questionnaire for capture or update mother's history |
No resources found
No resources found
Note: links and images are rebased to the (stated) source
Generated Narrative: Questionnaire HIV.E1CaptureOrUpdateMotherSHistory
Language: en
Profiles: Extractable Questionnaire - StructureMap, CRMI Shareable Questionnaire, CRMI Publishable Questionnaire
| LinkID | Text | Cardinality | Type | Flags | Description & Constraints |
|---|---|---|---|---|---|
![]() | Questionnaire for capture or update mother's history | Questionnaire | http://smart.who.int/hiv/Questionnaire/HIV.E1CaptureOrUpdateMotherSHistory#0.4.4 | ||
![]() ![]() | Pregnant woman's first name | 0..1 | string | ||
![]() ![]() | Pregnant woman's surname | 0..1 | string | ||
![]() ![]() | Pregnant woman's unique ID | 0..1 | string | ||
![]() ![]() | Antenatal care number | 0..1 | string | ||
![]() ![]() | Gestational age | 1..1 | integer | ||
![]() ![]() | Source of gestational age | 1..1 | choice | Value Set: #HIV.E.DE6 | |
![]() ![]() | Expected date of delivery (EDD) | 1..1 | date | ||
![]() ![]() | Number of pregnancies (gravida) | 1..1 | integer | ||
![]() ![]() | Number of previous pregnancies | 1..1 | integer | ||
![]() ![]() | Number of miscarriages and/or abortions | 1..1 | integer | ||
![]() ![]() | Number of live births | 1..1 | integer | ||
![]() ![]() | Number of caesarian sections | 1..1 | integer | ||
![]() ![]() | Number of stillbirths | 1..1 | integer | ||
![]() ![]() | Past pregnancy complications | 0..1 | choice | Value Set: #HIV.E.DE17 | |
![]() ![]() | Other past pregnancy problems (specify) | 0..1 | string | ||
![]() ![]() | Parity | 1..1 | integer | ||
![]() ![]() | Pregnancy in HIV-infected woman | 0..1 | boolean | ||
![]() ![]() | Date new pregnancy of HIV-positive woman identified | 0..1 | date | ||
![]() ![]() | ANC contact during pregnancy | 0..1 | boolean | ||
![]() ![]() | Date of first ANC visit | 0..1 | date | ||
![]() ![]() | Timing of ART initiation | 0..1 | choice | Value Set: #HIV.E.DE41 | |
![]() ![]() | Maternal use of recommended ART regimen | 0..1 | boolean | ||
![]() ![]() | Delivery date | 1..1 | date | ||
![]() ![]() | Pregnancy outcome | 0..1 | choice | Value Set: #HIV.E.DE47 | |
![]() ![]() | Delivery mode | 0..1 | choice | Value Set: #HIV.E.DE52 | |
![]() ![]() | Indications for caesarian section (C/S) | 0..1 | string | ||
![]() ![]() | Obstetric complications | 0..1 | string | ||
![]() ![]() | Live birth | 0..1 | boolean | ||
![]() ![]() | Live birth to an HIV-positive woman | 0..1 | boolean | ||
![]() ![]() | Gestational age at birth | 0..1 | integer | ||
![]() ![]() | Small for gestational age (SGA) | 0..1 | boolean | ||
![]() ![]() | Preterm birth status | 0..1 | choice | Value Set: #HIV.E.DE62 | |
![]() ![]() | Maternal ART start date | 0..1 | date | ||
![]() ![]() | Place of delivery | 1..1 | choice | Value Set: #HIV.E.DE67 | |
![]() ![]() | Other (specify) | 0..1 | string | ||
![]() ![]() | Delivery facility | 0..1 | string | ||
![]() ![]() | Date of miscarriage or abortion | 0..1 | date | ||
![]() ![]() | Infant's first name | 1..1 | string | ||
![]() ![]() | Infant's surname | 1..1 | string | ||
![]() ![]() | Infant's unique ID | 1..1 | string | ||
![]() ![]() | Mother's first name | 0..1 | string | ||
![]() ![]() | Mother's surname | 0..1 | string | ||
![]() ![]() | Mother's unique ID | 0..1 | string | ||
![]() ![]() | Caregiver's first name | 0..1 | string | ||
![]() ![]() | Caregiver's surname | 0..1 | string | ||
![]() ![]() | Caregiver's unique identifier | 0..1 | string | ||
![]() ![]() | ANC contact date | 1..1 | dateTime | ||
![]() ![]() | Referral | 1..1 | boolean | ||
![]() ![]() | Infant date of birth | 0..1 | date | ||
![]() ![]() | Date of birth of infant unknown | 0..1 | boolean | ||
![]() ![]() | Estimated age of infant | 0..1 | integer | ||
![]() ![]() | Age of infant | 0..1 | integer | ||
![]() ![]() | Gender of infant | 1..1 | choice | Value Set: #HIV.E.DE91 | |
![]() ![]() | Key population member | 0..1 | boolean | ||
![]() ![]() | Key population member type | 0..1 | choice | Value Set: #HIV.E.DE114 | |
![]() ![]() | Taking iron and folic acid (IFA) tablets | 0..1 | boolean | ||
![]() ![]() | Amount of iron prescribed | 0..1 | integer | ||
![]() ![]() | Type of iron supplement dosage provided | 0..1 | choice | Value Set: #HIV.E.DE136 | |
![]() ![]() | Amount of daily dose of folic acid prescribed | 0..1 | integer | ||
![]() ![]() | Maternal HIV status | 0..1 | choice | Value Set: #HIV.E.DE141 | |
![]() ![]() | Maternal HIV status at first ANC visit | 0..1 | choice | Value Set: #HIV.E.DE145 | |
![]() ![]() | Signs of substantial risk of HIV infection | 1..1 | choice | Value Set: #HIV.E.DE155 | |
![]() ![]() | Serodiscordant partner | 0..1 | boolean | ||
![]() ![]() | Date woman received counselling for CPT | 0..1 | date | ||
![]() ![]() | Date woman received counselling for TPT | 0..1 | date | ||
![]() ![]() | Maternal and child health service visit | 0..1 | choice | Value Set: #HIV.E.DE173 | |
![]() ![]() | Weeks postpartum | 0..1 | integer | ||
![]() ![]() | Timing of additional infant HIV test | 0..1 | integer | ||
![]() ![]() | Date of sample collection of additional infant HIV test | 0..1 | date | ||
![]() ![]() | Haemoglobin (Hb) result | 0..1 | integer | ||
![]() ![]() | Blood group and Rh factor | 0..1 | choice | Value Set: #HIV.E.DE246 | |
![]() ![]() | Asymptomatic bacteriuria (ASB) test result | 0..1 | choice | Value Set: #HIV.E.DE255 | |
![]() ![]() | Urine protein test result | 0..1 | choice | Value Set: #HIV.E.DE259 | |
![]() ![]() | Type of hypertensive disorder | 0..1 | choice | Value Set: #HIV.E.DE264 | |
{
"resourceType": "Questionnaire",
"id": "HIV.E1CaptureOrUpdateMotherSHistory",
"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.E1CaptureOrUpdateMotherSHistory",
"version": "0.4.4",
"title": "Capture or update mother's history",
"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 capture or update mother's history",
"item": [
{
"id": "HIV.E.DE1",
"linkId": "HIV.E.DE1",
"text": "Pregnant woman's first name",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE2",
"linkId": "HIV.E.DE2",
"text": "Pregnant woman's surname",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE3",
"linkId": "HIV.E.DE3",
"text": "Pregnant woman's unique ID",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE4",
"linkId": "HIV.E.DE4",
"text": "Antenatal care number",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE5",
"linkId": "HIV.E.DE5",
"text": "Gestational age",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE6",
"linkId": "HIV.E.DE6",
"text": "Source of gestational age",
"type": "choice",
"required": true,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE6"
},
{
"id": "HIV.E.DE10",
"linkId": "HIV.E.DE10",
"text": "Expected date of delivery (EDD)",
"type": "date",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE11",
"linkId": "HIV.E.DE11",
"text": "Number of pregnancies (gravida)",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE12",
"linkId": "HIV.E.DE12",
"text": "Number of previous pregnancies",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE13",
"linkId": "HIV.E.DE13",
"text": "Number of miscarriages and/or abortions",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE14",
"linkId": "HIV.E.DE14",
"text": "Number of live births",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE15",
"linkId": "HIV.E.DE15",
"text": "Number of caesarian sections",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE16",
"linkId": "HIV.E.DE16",
"text": "Number of stillbirths",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE17",
"linkId": "HIV.E.DE17",
"text": "Past pregnancy complications",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE17"
},
{
"id": "HIV.E.DE35",
"linkId": "HIV.E.DE35",
"text": "Other past pregnancy problems (specify)",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE36",
"linkId": "HIV.E.DE36",
"text": "Parity",
"type": "integer",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE37",
"linkId": "HIV.E.DE37",
"text": "Pregnancy in HIV-infected woman",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE38",
"linkId": "HIV.E.DE38",
"text": "Date new pregnancy of HIV-positive woman identified",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE39",
"linkId": "HIV.E.DE39",
"text": "ANC contact during pregnancy",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE40",
"linkId": "HIV.E.DE40",
"text": "Date of first ANC visit",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE41",
"linkId": "HIV.E.DE41",
"text": "Timing of ART initiation",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE41"
},
{
"id": "HIV.E.DE45",
"linkId": "HIV.E.DE45",
"text": "Maternal use of recommended ART regimen",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE46",
"linkId": "HIV.E.DE46",
"text": "Delivery date",
"type": "date",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE47",
"linkId": "HIV.E.DE47",
"text": "Pregnancy outcome",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE47"
},
{
"id": "HIV.E.DE52",
"linkId": "HIV.E.DE52",
"text": "Delivery mode",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE52"
},
{
"id": "HIV.E.DE56",
"linkId": "HIV.E.DE56",
"text": "Indications for caesarian section (C/S)",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE57",
"linkId": "HIV.E.DE57",
"text": "Obstetric complications",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE58",
"linkId": "HIV.E.DE58",
"text": "Live birth",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE59",
"linkId": "HIV.E.DE59",
"text": "Live birth to an HIV-positive woman",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE60",
"linkId": "HIV.E.DE60",
"text": "Gestational age at birth",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE61",
"linkId": "HIV.E.DE61",
"text": "Small for gestational age (SGA)",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE62",
"linkId": "HIV.E.DE62",
"text": "Preterm birth status",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE62"
},
{
"id": "HIV.E.DE66",
"linkId": "HIV.E.DE66",
"text": "Maternal ART start date",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE67",
"linkId": "HIV.E.DE67",
"text": "Place of delivery",
"type": "choice",
"required": true,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE67"
},
{
"id": "HIV.E.DE71",
"linkId": "HIV.E.DE71",
"text": "Other (specify)",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE72",
"linkId": "HIV.E.DE72",
"text": "Delivery facility",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE73",
"linkId": "HIV.E.DE73",
"text": "Date of miscarriage or abortion",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE76",
"linkId": "HIV.E.DE76",
"text": "Infant's first name",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE77",
"linkId": "HIV.E.DE77",
"text": "Infant's surname",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE78",
"linkId": "HIV.E.DE78",
"text": "Infant's unique ID",
"type": "string",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE79",
"linkId": "HIV.E.DE79",
"text": "Mother's first name",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE80",
"linkId": "HIV.E.DE80",
"text": "Mother's surname",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE81",
"linkId": "HIV.E.DE81",
"text": "Mother's unique ID",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE82",
"linkId": "HIV.E.DE82",
"text": "Caregiver's first name",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE83",
"linkId": "HIV.E.DE83",
"text": "Caregiver's surname",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE84",
"linkId": "HIV.E.DE84",
"text": "Caregiver's unique identifier",
"type": "string",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE85",
"linkId": "HIV.E.DE85",
"text": "ANC contact date",
"type": "dateTime",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE86",
"linkId": "HIV.E.DE86",
"text": "Referral",
"type": "boolean",
"required": true,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE87",
"linkId": "HIV.E.DE87",
"text": "Infant date of birth",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE88",
"linkId": "HIV.E.DE88",
"text": "Date of birth of infant unknown",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE89",
"linkId": "HIV.E.DE89",
"text": "Estimated age of infant",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE90",
"linkId": "HIV.E.DE90",
"text": "Age of infant",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE91",
"linkId": "HIV.E.DE91",
"text": "Gender of infant",
"type": "choice",
"required": true,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE91"
},
{
"id": "HIV.E.DE113",
"linkId": "HIV.E.DE113",
"text": "Key population member",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE114",
"linkId": "HIV.E.DE114",
"text": "Key population member type",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE114"
},
{
"id": "HIV.E.DE134",
"linkId": "HIV.E.DE134",
"text": "Taking iron and folic acid (IFA) tablets",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE135",
"linkId": "HIV.E.DE135",
"text": "Amount of iron prescribed",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE136",
"linkId": "HIV.E.DE136",
"text": "Type of iron supplement dosage provided",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE136"
},
{
"id": "HIV.E.DE139",
"linkId": "HIV.E.DE139",
"text": "Amount of daily dose of folic acid prescribed",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE141",
"linkId": "HIV.E.DE141",
"text": "Maternal HIV status",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE141"
},
{
"id": "HIV.E.DE145",
"linkId": "HIV.E.DE145",
"text": "Maternal HIV status at first ANC visit",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE145"
},
{
"id": "HIV.E.DE155",
"linkId": "HIV.E.DE155",
"text": "Signs of substantial risk of HIV infection",
"type": "choice",
"required": true,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE155"
},
{
"id": "HIV.E.DE160",
"linkId": "HIV.E.DE160",
"text": "Serodiscordant partner",
"type": "boolean",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE161",
"linkId": "HIV.E.DE161",
"text": "Date woman received counselling for CPT",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE162",
"linkId": "HIV.E.DE162",
"text": "Date woman received counselling for TPT",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE173",
"linkId": "HIV.E.DE173",
"text": "Maternal and child health service visit",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE173"
},
{
"id": "HIV.E.DE177",
"linkId": "HIV.E.DE177",
"text": "Weeks postpartum",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE243",
"linkId": "HIV.E.DE243",
"text": "Timing of additional infant HIV test",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE244",
"linkId": "HIV.E.DE244",
"text": "Date of sample collection of additional infant HIV test",
"type": "date",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE245",
"linkId": "HIV.E.DE245",
"text": "Haemoglobin (Hb) result",
"type": "integer",
"required": false,
"repeats": false,
"readOnly": false
},
{
"id": "HIV.E.DE246",
"linkId": "HIV.E.DE246",
"text": "Blood group and Rh factor",
"type": "choice",
"required": false,
"repeats": false,
"readOnly": false,
"answerValueSet": "#HIV.E.DE246"
},
{
"id": "HIV.E.DE255",
"linkId": "HIV.E.DE255",
"text": "Asymptomatic bacteriuria (ASB) test result",
"type": "choice",
"required": false,
"repeats": false,
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}