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ID

16220

Description

Form provided by Binyam Tilahun. Source: http://www.moh.gov.et/ (Ministry of Health, Ethiopia)

Link

http://www.moh.gov.et/

Keywords

Versions (1)
  1. 7/6/16 7/6/16 -
Uploaded on

July 6, 2016

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License

Creative Commons BY-NC 3.0
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    Ministry of Health, Ethiopia- HMIS HIV exposed infant logbook card

    English

    HIV exposed infant logbook card

    1 forms  
    Logbook card
    Description

    Logbook card

    Registration number
    Description

    Registration number

    Data type

    text

    Alias
    UMLS CUI [1]
    C0421512
    Date of enrollment
    Description

    Enrollment date

    Data type

    date

    Alias
    UMLS CUI [1,1]
    C0011008
    UMLS CUI [1,2]
    C0679646
    UMLS CUI [1,3]
    C1516879
    Name of Infant
    Description

    Name

    Data type

    text

    Alias
    UMLS CUI [1]
    C0027365
    Name of father
    Description

    Name

    Data type

    text

    Alias
    UMLS CUI [1]
    C0027365
    Name of grandfather
    Description

    Name

    Data type

    text

    Alias
    UMLS CUI [1]
    C0027365
    Name of caregiver
    Description

    Name

    Data type

    text

    Alias
    UMLS CUI [1]
    C0027365
    Infant´s Medical record number (MRN)
    Description

    Medical record number

    Data type

    text

    Alias
    UMLS CUI [1]
    C1301894
    Date of birth
    Description

    Date of birth

    Data type

    date

    Alias
    UMLS CUI [1]
    C0421451
    Age at enrollment
    Description

    under 3 months, enter age in weeks over 3 months, enter age in months

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0001779
    Specify if age at enrollment is in weeks or in months
    Description

    Age

    Data type

    text

    Alias
    UMLS CUI [1]
    C0001779
    Sex
    Description

    Sex

    Data type

    integer

    Alias
    UMLS CUI [1]
    C0079399
    Infant referred from (Name of source)
    Description

    Referral

    Data type

    text

    Alias
    UMLS CUI [1]
    C0034927
    Did the infant receive ARV prophylaxis at birth?
    Description

    ARV prophylaxis

    Data type

    boolean

    Alias
    UMLS CUI [1,1]
    C0599685
    UMLS CUI [1,2]
    C0199176
    Does the infant come for follow up at the age of 6 weeks?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 10 weeks?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 14 weeks?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 4 months?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 5 months?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 6 months?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 9 months?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 12 months?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 15 months?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Does the infant come for follow up at the age of 18 months?
    Description

    Follow up

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1522577
    Final outcome
    Description

    Final outcome

    Data type

    text

    Alias
    UMLS CUI [1]
    C0085565
    Enrolled in care?
    Description

    Enrollment

    Data type

    boolean

    Alias
    UMLS CUI [1]
    C1516879
    If enrolled in care,please specify
    Description

    Enrollment

    Data type

    integer

    Alias
    UMLS CUI [1]
    C1516879
    Remarks
    Description

    Remarks

    Data type

    text

    Alias
    UMLS CUI [1]
    C0947611
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    Similar models

    HIV exposed infant logbook card

    1 forms
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Logbook card
    Registration number
    Item
    Registration number
    text
    C0421512 (UMLS CUI [1])
    Enrollment date
    Item
    Date of enrollment
    date
    C0011008 (UMLS CUI [1,1])
    C0679646 (UMLS CUI [1,2])
    C1516879 (UMLS CUI [1,3])
    Name
    Item
    Name of Infant
    text
    C0027365 (UMLS CUI [1])
    Name
    Item
    Name of father
    text
    C0027365 (UMLS CUI [1])
    Name
    Item
    Name of grandfather
    text
    C0027365 (UMLS CUI [1])
    Name
    Item
    Name of caregiver
    text
    C0027365 (UMLS CUI [1])
    Medical record number
    Item
    Infant´s Medical record number (MRN)
    text
    C1301894 (UMLS CUI [1])
    Date of birth
    Item
    Date of birth
    date
    C0421451 (UMLS CUI [1])
    Age
    Item
    Age at enrollment
    integer
    C0001779 (UMLS CUI [1])
    Age
    Item
    Specify if age at enrollment is in weeks or in months
    text
    C0001779 (UMLS CUI [1])
    Item
    Sex
    integer
    C0079399 (UMLS CUI [1])
    Sex
    Code List
    Sex
    CL Item
    male (1)
    CL Item
    female (2)
    Referral
    Item
    Infant referred from (Name of source)
    text
    C0034927 (UMLS CUI [1])
    ARV prophylaxis
    Item
    Did the infant receive ARV prophylaxis at birth?
    boolean
    C0599685 (UMLS CUI [1,1])
    C0199176 (UMLS CUI [1,2])
    Follow up
    Item
    Does the infant come for follow up at the age of 6 weeks?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 10 weeks?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 14 weeks?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 4 months?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 5 months?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 6 months?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 9 months?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 12 months?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 15 months?
    boolean
    C1522577 (UMLS CUI [1])
    Follow up
    Item
    Does the infant come for follow up at the age of 18 months?
    boolean
    C1522577 (UMLS CUI [1])
    Item
    Final outcome
    text
    C0085565 (UMLS CUI [1])
    Final outcome
    Code List
    Final outcome
    CL Item
    infected (I)
    CL Item
    not infected (NI)
    Enrollment
    Item
    Enrolled in care?
    boolean
    C1516879 (UMLS CUI [1])
    Item
    If enrolled in care,please specify
    integer
    C1516879 (UMLS CUI [1])
    Enrollment
    Code List
    If enrolled in care,please specify
    CL Item
    Pre (1)
    CL Item
    ART (2)
    CL Item
    No (3)
    CL Item
    UAN (4)
    Remarks
    Item
    Remarks
    text
    C0947611 (UMLS CUI [1])
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