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 |
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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 | |
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"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, "readOnly": false, "answerValueSet": "#HIV.E.DE255" }, { "id": "HIV.E.DE259", "linkId": "HIV.E.DE259", "text": "Urine protein test result", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.E.DE259" }, { "id": "HIV.E.DE264", "linkId": "HIV.E.DE264", "text": "Type of hypertensive disorder", "type": "choice", "required": false, "repeats": false, "readOnly": false, "answerValueSet": "#HIV.E.DE264" } ] }