ID

16220

Descripción

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

Link

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

Palabras clave

Versiones (1)
  1. 6/7/16 6/7/16 -
Subido en

6 de julio de 2016

DOI

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Licencia

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

Inglés

HIV exposed infant logbook card

1 formularios  
Logbook card
Descripción

Logbook card

Registration number
Descripción

Registration number

Tipo de datos

text

Alias
UMLS CUI [1]
C0421512
Date of enrollment
Descripción

Enrollment date

Tipo de datos

date

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

Name

Tipo de datos

text

Alias
UMLS CUI [1]
C0027365
Name of father
Descripción

Name

Tipo de datos

text

Alias
UMLS CUI [1]
C0027365
Name of grandfather
Descripción

Name

Tipo de datos

text

Alias
UMLS CUI [1]
C0027365
Name of caregiver
Descripción

Name

Tipo de datos

text

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

Medical record number

Tipo de datos

text

Alias
UMLS CUI [1]
C1301894
Date of birth
Descripción

Date of birth

Tipo de datos

date

Alias
UMLS CUI [1]
C0421451
Age at enrollment
Descripción

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

Tipo de datos

integer

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

Age

Tipo de datos

text

Alias
UMLS CUI [1]
C0001779
Sex
Descripción

Sex

Tipo de datos

integer

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

Referral

Tipo de datos

text

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

ARV prophylaxis

Tipo de datos

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?
Descripción

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

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

Follow up

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1522577
Final outcome
Descripción

Final outcome

Tipo de datos

text

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

Enrollment

Tipo de datos

boolean

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

Enrollment

Tipo de datos

integer

Alias
UMLS CUI [1]
C1516879
Remarks
Descripción

Remarks

Tipo de datos

text

Alias
UMLS CUI [1]
C0947611
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Similar models

HIV exposed infant logbook card

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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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