Informações:
Falhas:
ID
16212
Descrição
Form provided by Binyam Tilahun. Source: http://www.moh.gov.et/ (Ministry of Health, Ethiopia)
Link
Palavras-chave
Versões (1)
- 05/07/2016 05/07/2016 -
Transferido a
5 de julho de 2016
DOI
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Licença
Creative Commons BY-NC 3.0
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Ministry of Health, Ethiopia- HIV–Exposed Infant Follow up Card
HIV–Exposed Infant Follow up Card
- StudyEvent: ODM
Similar models
HIV–Exposed Infant Follow up Card
- StudyEvent: ODM
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Facility name
Item
Facility name
text
C0018704 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
C0027365 (UMLS CUI [1,2])
Date of Enrollment
Item
Date of Enrollment
date
C2986327 (UMLS CUI [1])
Medical record number
Item
Infants Medical record number
text
C1301894 (UMLS CUI [1])
Patient Identifier
Item
Unique "HIV exposed infant- HEI" ID
text
C0030705 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,2])
Referral
Item
Infant referred from
text
C0034927 (UMLS CUI [1])
Name
Item
Name of Infant
text
C0027365 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Place of birth
Item
Place of birth
text
C0032040 (UMLS CUI [1])
Age
Item
Age at enrollment
integer
C0001779 (UMLS CUI [1])
Mothers name/caretakers name
Item
Mothers name/caretakers name
text
C0802060 (UMLS CUI [1])
C0085537 (UMLS CUI [2,1])
C0027365 (UMLS CUI [2,2])
C0085537 (UMLS CUI [2,1])
C0027365 (UMLS CUI [2,2])
Mothers MRN
Item
Mothers MRN
text
C1301894 (UMLS CUI [1])
Caregiver
Item
If "Caretaker" describe relationship
text
C0085537 (UMLS CUI [1])
Address
Item
Address:Region
text
C0421449 (UMLS CUI [1])
Address
Item
Address: Subcity
text
C0421449 (UMLS CUI [1])
Address
Item
Address: Kebelle
text
C0421449 (UMLS CUI [1])
Address
Item
Address: House number
integer
C0421449 (UMLS CUI [1])
Phone number
Item
Patient contact: phone number
integer
C1515258 (UMLS CUI [1])
CL Item
Alive (1)
CL Item
Dead (2)
CL Item
enrolled in HIV/ART care (1)
CL Item
Not enrolled in HIV/ART care (2)
CL Item
Within the facility (1)
CL Item
Out of the facility (specify) (2)
Mothers status
Item
Mothers status: specify facility
text
C2029853 (UMLS CUI [1])
Item
Mothers PMTCT intervention
integer
C3845698 (UMLS CUI [1,1])
C1273869 (UMLS CUI [1,2])
C1273869 (UMLS CUI [1,2])
CL Item
None (1)
CL Item
sdNVP (2)
CL Item
AZT + sdNVP + 3TC (3)
CL Item
Other:(specify regimen & duration) (4)
PMTCT intervention
Item
Mothers PMTCT intervention:specify other regimen & duration
text
C3845698 (UMLS CUI [1,1])
C1273869 (UMLS CUI [1,2])
C1273869 (UMLS CUI [1,2])
Item
Infant Antiretroviral prophylaxis
integer
C0599685 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
CL Item
None (1)
CL Item
SdNVP (2)
CL Item
SdNVP+AZT for 7days (3)
CL Item
Other specify (Regimen & duration) (4)
Item
Infant Antiretroviral prophylaxis: specify other Regimen & duration
text
C0599685 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
Code List
Infant Antiretroviral prophylaxis: specify other Regimen & duration
CL Item
Positive (1)
CL Item
Negative (2)
CL Item
Unknown (3)
CL Item
Alive (1)
CL Item
Dead (2)
CL Item
enrolled in HIV/ART care (1)
CL Item
Not enrolled in HIV/ART care (2)
Immunizations
Item
Immunizations:BCG
boolean
C0020971 (UMLS CUI [1])
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
Immunizations
Item
Immunizations:Measles
boolean
C0020971 (UMLS CUI [1])
Visit date
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Age
Item
Age
integer
C0001779 (UMLS CUI [1])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Length
Item
Infant length
integer
C1444754 (UMLS CUI [1])
Head circumference
Item
Head circumference
float
C0262499 (UMLS CUI [1])
CL Item
normal (1)
CL Item
if there is growth failure (2)
CL Item
Appropriate (A)
CL Item
Delay (D)
CL Item
Regression (R)
CL Item
Infant is on exclusive breastfeeding (1)
CL Item
Infant is on exclusive replacement feeding (2)
CL Item
Infant is on mixed feeding (3)
CL Item
Infant is on breastfeeding and complementar (4)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
Item
Abnormal findings or diagnosis that may suggest HIV infection
integer
C1704258 (UMLS CUI [1])
CL Item
none (0)
CL Item
Generalized lymphadenopathy (1)
CL Item
Oral Candidiasis (2)
CL Item
Purulent ear discharge (3)
CL Item
Findings suggestive of pneumonia or lower respiratory tract infections (4)
CL Item
Persistent diarrhea (5)
CL Item
Hepatosplenomegaly (6)
CL Item
Severe skin lesions (7)
CL Item
Persisten (8)
Treatment/medication
Item
Treatment/medication given
text
C0013216 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,2])
Cotrimoxazole prophylaxis
Item
Cotrimoxazole prophylaxis:dose
integer
C0041044 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
Item
Cotrimoxazole prophylaxis: Adherence
integer
C0041044 (UMLS CUI [1,1])
C0199176 (UMLS CUI [1,2])
C0199176 (UMLS CUI [1,2])
CL Item
Good (1)
CL Item
Fair (2)
CL Item
Poor (3)
CL Item
Sample collected for DNA PCR (1)
CL Item
Sample collected for DNA PCR (1)
CL Item
DNA/PCR result negative (2)
CL Item
DNA/PCR result Positive (3)
CL Item
Rapid antibodytest result negative (4)
CL Item
Rapid antibodytest result positive (5)
CL Item
DNA/PCR test result inditerminate (6)
CL Item
No test done (0)
Item
Conclusion & Decision
integer
C1707478 (UMLS CUI [1])
C0679006 (UMLS CUI [2])
C0679006 (UMLS CUI [2])
CL Item
Infant has no clinical or laboratory evidence of HIV infection currently but needs follow up (0)
CL Item
Infant has clinical evidence of HIV infection and is referred for Pediatric HIV/ART care with in the facility (1)
CL Item
Infant has lab evidence of HIV infection and referred to pediatric HIV/ART care with in the facility (2)
CL Item
infant has clincial and laboratory evidence of HIV infection and referred for pediatric HIV care/ART with in the facility (3)
CL Item
Infant has clinical evidence of HIV infection and is referred for Pediatric HIVcare/ART outside the facility (4)
CL Item
Infant has laboratory evidence of HIV infection and is referred for Pediatric HIV care/ART outside the facility (5)
CL Item
Infant has clinical and laboratory evidence of HIV infection and referred for Pediatric HIV care/ART outside the facility (6)
CL Item
Infant is confirmed not to have clinical and lab evidence of HIV infection and discharged from follow up (7)
CL Item
Any Other conclusion Specify (Including Death & lost to follow up) (8)
Conclusion & Decision
Item
Conclusion & Decision: Specify Any Other conclusion (Including Death & lost to follow up)
text
C1707478 (UMLS CUI [1])
C0679006 (UMLS CUI [2])
C0679006 (UMLS CUI [2])
Discharged, Name of Health Care provider
Item
Name of Health Care provider who referred or discharged the Infant from follow up
text
C0586514 (UMLS CUI [1,1])
C2361125 (UMLS CUI [1,2])
C2361125 (UMLS CUI [1,2])
Discharged, Signature of Health Care provider
Item
Signature of Health Care provider who referred or discharged the Infant from follow up
text
C0586514 (UMLS CUI [1,1])
C0807938 (UMLS CUI [1,2])
C0807938 (UMLS CUI [1,2])
Date of discharge
Item
Date of discharge
date
C2361123 (UMLS CUI [1])