Facility name
Item
Facility name
text
C0018704 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
Patient card number
Item
Patient card number
integer
C0030705 (UMLS CUI [1,1])
C1549704 (UMLS CUI [1,2])
ART unique number
Item
ART unique number
integer
C1963724 (UMLS CUI [1,1])
C2735568 (UMLS CUI [1,2])
Tuberculosis Card number
Item
Tuberculosis Card number
integer
C0041296 (UMLS CUI [1,1])
C1549704 (UMLS CUI [1,2])
PMTCT Confidentiality Code
Item
PMTCT Confidentiality Code
integer
C3845698 (UMLS CUI [1,1])
C1547595 (UMLS CUI [1,2])
Patient Name
Item
Patient´s Name
text
C1299487 (UMLS CUI [1])
Age
Item
Age
integer
C0001779 (UMLS CUI [1])
Item
Gender
integer
C0079399 (UMLS CUI [1])
Height
Item
Body height
float
C0005890 (UMLS CUI [1])
Patient address
Item
Patient address: Region
text
C0421449 (UMLS CUI [1])
Patient address
Item
Patient address: Wereda/Subcity
text
C0421449 (UMLS CUI [1])
Patient address
Item
Patient address: Kebele
text
C0421449 (UMLS CUI [1])
Patient address
Item
Patient address: House number
integer
C0421449 (UMLS CUI [1])
Telephone
Item
Telephone number
integer
C1515258 (UMLS CUI [1])
Date HIV positivity confirmed
Item
Date HIV positivity confirmed
date
C0011008 (UMLS CUI [1,1])
C0019699 (UMLS CUI [1,2])
C0750484 (UMLS CUI [1,3])
Item
HIV Test Type
integer
C0459958 (UMLS CUI [1,1])
C0449570 (UMLS CUI [1,2])
CL Item
Rapid HIV Tests (1)
CL Item
PCR (in children) (3)
Eligibility Date
Item
Eligibility Date
date
C1976613 (UMLS CUI [1])
Item
Why eligible? Please select
integer
C0013893 (UMLS CUI [1])
Code List
Why eligible? Please select
CL Item
Clinical only (1)
CL Item
Transfer In (TI) (4)
Date eligible and ready
Item
Please enter the date when patient is medically eligible and ready (counseled for adherence) for ART
date
C1829734 (UMLS CUI [1,1])
C0010210 (UMLS CUI [1,2])
Item
Please specify whether patient receives free ART or pays for ART
integer
C0585761 (UMLS CUI [1])
Code List
Please specify whether patient receives free ART or pays for ART
Item
Visit Type
text
C0545082 (UMLS CUI [1])
Follow-Up date
Item
Follow up date
date
C3694716 (UMLS CUI [1])
Months on ART
Item
Months on ART
text
C1963724 (UMLS CUI [1,1])
C1976623 (UMLS CUI [1,2])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Pregnancy
Item
Pregnancy
boolean
C0032961 (UMLS CUI [1])
Estimated due date
Item
If pregnant, please specify estimated due date
date
C2825543 (UMLS CUI [1])
Item
Family planning method
integer
C0700589 (UMLS CUI [1])
Code List
Family planning method
CL Item
oral contraceptive pills (2)
CL Item
injectable/implantable hormones (3)
CL Item
Diaphragm/cervical cap (4)
CL Item
Intrauterine device (5)
CL Item
Vasectomy/tubal ligation (6)
Height
Item
Height of child
float
C0005890 (UMLS CUI [1])
Head circumference
Item
Head circumference
float
C0262499 (UMLS CUI [1])
Item
Patient functional status
text
C0598463 (UMLS CUI [1])
Code List
Patient functional status
CL Item
working (able to perform work in or out of the house,harvest,go to school,for children normal activities or play (W)
CL Item
Ambulatory (able to perform activities of daily living) (A)
CL Item
Bedridden (unable to perform activities of daily living) (B)
Item
Developmental milestones
text
C2983568 (UMLS CUI [1])
Code List
Developmental milestones
Item
WHO human immunodeficiency virus stage
integer
C1976611 (UMLS CUI [1])
Code List
WHO human immunodeficiency virus stage
Item
Tuberculosis screening
integer
C0420004 (UMLS CUI [1])
Code List
Tuberculosis screening
Item
Tuberculosis prophylaxis
text
C0740413 (UMLS CUI [1])
Code List
Tuberculosis prophylaxis
CL Item
Currently on INH prophylaxis (INH)
CL Item
Currently on DOTS (TB Rx)
Item
Tuberculosis prophylaxis:please specify months on treatment
text
C0740413 (UMLS CUI [1])
Code List
Tuberculosis prophylaxis:please specify months on treatment
Item
Other Infections
text
C0009450 (UMLS CUI [1])
Code List
Other Infections
CL Item
Bacterial Pneumonia (BP)
CL Item
Pulmonary TB (PTB)
CL Item
Extrapulmonary TB (ETB)
CL Item
Thrush- oral/vaginal (T)
CL Item
Ulcers-mouth, genital (U)
CL Item
Diarrhea chronic (DC)
CL Item
Diarrhea acute (DA)
CL Item
Pneumocystis pneumonia (PCP)
CL Item
CNS Toxoplasmosis (CT)
CL Item
Cryptococcal Meningitis (CM)
Cotrimoxazole
Item
Cotrimoxazole
boolean
C0041044 (UMLS CUI [1])
Cotrimoxazole dispensed dose
Item
Dispensed dose, please note the number of dispensed doses
integer
C0041044 (UMLS CUI [1,1])
C0805077 (UMLS CUI [1,2])
Item
Therapy adherence
text
C1321605 (UMLS CUI [1])
Code List
Therapy adherence
Item
If fair or poor therapy adherence, please specify reason
integer
C1321605 (UMLS CUI [1])
Code List
If fair or poor therapy adherence, please specify reason
CL Item
Toxicity/side effects (1)
CL Item
Share with others (2)
CL Item
Stigma,Disclosure (6)
CL Item
Drug stock out (7)
CL Item
Lost/ran out of pills (8)
CL Item
Delivery/travel problems (9)
CL Item
Inability to pay (10)
Other Medication
Item
Any other medication dispensed
text
C0013227 (UMLS CUI [1])
Item
Antiretroviral therapy adherence
text
C1963724 (UMLS CUI [1,1])
C1321605 (UMLS CUI [1,2])
Code List
Antiretroviral therapy adherence
Item
If therapy adherence is fair or poor,please specify why
text
C1963724 (UMLS CUI [1,1])
C1321605 (UMLS CUI [1,2])
Code List
If therapy adherence is fair or poor,please specify why
CL Item
Toxicity/side effects (1)
CL Item
Share with others (2)
CL Item
Stigma,Disclosure (6)
CL Item
Drug stock out (7)
CL Item
Lost/ran out of pills (8)
CL Item
Delivery/travel problems (9)
CL Item
Inability to pay (10)
Antiretroviral therapy Dispense code
Item
Antiretroviral therapy Dispense code
text
C1963724 (UMLS CUI [1,1])
C2735568 (UMLS CUI [1,2])
Antiretroviral therapy Dispense code
Item
Antiretroviral therapy Dispense code
text
C1963724 (UMLS CUI [1,1])
C2735568 (UMLS CUI [1,2])
Antiretroviral therapy dispensed dose
Item
Antiretroviral therapy dispensed dose
integer
C1963724 (UMLS CUI [1,1])
C0805077 (UMLS CUI [1,2])
Item
Antiretroviral therapy side effects
integer
C1963724 (UMLS CUI [1,1])
C0879626 (UMLS CUI [1,2])
Code List
Antiretroviral therapy side effects
CL Item
Numbness/Tingling (5)
CL Item
Abdominal pain (8)
CL Item
dizzy,anxiety, night mare (11)
Item
Reason for change of treatment
integer
C1299575 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Code List
Reason for change of treatment
CL Item
Toxicity/side effects (1)
CL Item
Risk of Pregnancy (3)
CL Item
Due to new TB (4)
CL Item
New Drug available (5)
CL Item
Drug out of stock (6)
CL Item
immunologic failure (8)
CL Item
Virologic failure (9)
Item
Reason for treatment stop
integer
C0392360 (UMLS CUI [1,1])
C1947925 (UMLS CUI [1,2])
Code List
Reason for treatment stop
CL Item
Toxicity/side effects (1)
CL Item
Treatment failure (3)
CL Item
Poor adherence (4)
CL Item
Illness,hospitalization (5)
CL Item
Drugs out of stock (6)
CL Item
Patient lacks finances (7)
CL Item
Other patient decision (8)
CL Item
Planned treatment interruption (9)
CD4/mm3 or percent if <5yrs or TLC
Item
CD4/mm3 or percent if <5yrs or TLC
text
C0003323 (UMLS CUI [1])
Hemoglobine
Item
Hemoglobine
float
C0518015 (UMLS CUI [1])
ALT/AST
Item
ALT/AST
float
C0201836 (UMLS CUI [1,1])
C0201899 (UMLS CUI [1,2])
Date
Item
Next visit date
date
C0011008 (UMLS CUI [1])
Item
Please select if one of the below applies
text
C0449437 (UMLS CUI [1])
Code List
Please select if one of the below applies
CL Item
transferred out (TO)
CL Item
not seen since>/=1month<3months (Lost)
CL Item
Lost to follow up for > 3 months (Drop)