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

DOI

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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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