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 Meta Information

         Obtain start_time as current time

         Obtain end_time

         Obtain deviceid

         obtain subscriber_id

 

Survey Information

        gps_location field is required

        provider_id is required and use checkdigit

 

Household Information

       household_id is required, uses checkdigit  and must be unique

       catchment_area has calculated attribute which fills out the location, it is required.

         The calculated value MUST be adjusted by the PHCT administrators prior to installation of a form into a counsellor's device to indicate the location id of the counsellor.

       The village is a drop down list. The drop list is populated through a  lookup function that loads villages from a special csv file installed on the phone device. The special file fills out

            the location, sublocation, district and division

 

Were you accepted in?

  It is required field

 

 

Adults in Household

  hint:Must be 13 years old and above. If none, enter 0.

  This shows up when either the question "Were you accepted in?"'s answer is accepted/declined/not at home

  It is a required field. This Number must be 0 or more

 

Children in Household

    hint:Must be less than 13 years old. If none, enter 0.

    This shows up when  the question "Were you accepted in?"'s answer is accepted or declined or not at home

    It is required

    It is an integer field

    This Number must be 0 or more. If number of adults is 0 you cannot have 0 children

                        

                        

Total in Household

    hint:Confirm this total number of adults and children with CHW.

    This shows up when  the question "Were you accepted in?"'s answer is accepted or declined or not at home

    It is a read only internal field that is calculated by adding up household adults  and children under 13 years

    It is an integer field

 

Adults Eligible for Testing

    hint:Must be 13 years old and above. If none, enter 0.

    This shows up when  the question "Were you accepted in?"'s answer is accepted AND the number of Adults in Household is more than zero

    It is required

    The Number of eligible adults must be 0 or more but not more than number of adults in the household

                                

Children Eligible for Testing

    hint:Must be less than 13 years old. If none, enter 0.

    This shows up when  the question "Were you accepted in?"'s answer is accepted AND the number of Adults in Household is more than zero

 

Total Target/Eligible

    It is read only

    This shows up when  the question "Were you accepted in?"'s answer is accepted

        It is an aggrigate of eligible adults and children in an household:

 

              calculate="if ((../eligible_adults  > 0 and ../eligible_under13 > 0), ../eligible_adults + ../eligible_under13,

                                                               if(../eligible_adults > 0, ../eligible_adults, ../eligible_under13))"

              relevant="/form/survey/allowed_in='accepted'"

         

Schedule Return Date

    This shows up when  the question "Were you accepted in?"'s answer is allowed in

    Return date must be after today

                 relevant="../allowed_in='laterdate'"

         constraint=". >= today()"

 

Number of Bed Nets

    hint:If none, enter 0

        It is required

    Number of bed nets must be positive

           constraint=". >= 0"

 

Number of Nets Provided

    It is required

 

Voucher ID of Provided Net

    Response to "Number of Bed Nets" must be greater than zero

    It is required

Total Land Owned

    hint:Please enter in acres. If none, enter 0.</hint>                     

        It is required

        The number must be greater or equal to zero

    constraint=". &gt;= 0"

 

Number of Cows Owned

    hint:If none, enter 0

    It is required

        The number must be greater or equal to zero

    constraint=". &gt;= 0"

 

Number of Goats Owned

        hint:If none, enter 0

    It is required

        The number must be greater or equal to zero

    constraint=". &gt;= 0".

 

Number of Sheep Owned

          hint:If none, enter 0.

    It is required

        The number must be greater or equal to zero

    constraint=". &gt;= 0"

 

Children Between 3-20 Years

          hint:Include all children in household

    It is required

        The number must be greater or equal to zero

    constraint=". &gt;= 0 and . &lt;= /form/household/meta_data/total_household"

    This number cannot be more than people in household nor be less than 0

 

Children Attending School

    hint:Include pre-primary, primary through college

    Number of children in school must be less than or equal to the number in household and cannot be less than 0.

    It is required

    constraint=". &lt;= ../children_in_household and . &gt;= 0"

                        

Individual Data

===============

Household Counseling and Testing for the Household ID

    hint:Please confirm this ID is correct

        The field is calculated from  household Id provided at household level to help user confirm he/she is handling the correct household

        It is a read only

    constraint="review('Household ID', .)"

 

       Encounter

          encounter.encounter_datetime is a readonly whose value is picked from the phone device date

         encounter.provider_id is a readonly whose value is picked obtained from the survey section

         encounter.location_id is a readonly whose value is picked from the catchment area of the household section

         

      Patient

           Scan HCT AMRS ID

             hint:Ensure you have enough light.

             Use a Lunh check digit validation and must be unique

             It is input through barcode reader

             constraint="regex(., '^\w+[-]?\d{1}') and checkdigit(.) and unique('individual', .)"

             

           Enter HCT AMRS ID

             It is required

             Use a Lunh check digit validation and must be unique

           Shows up when  "Scan HCT AMRS ID" question is not filled out

       constraint="regex(., '^\w+[-]?\d{1}') and checkdigit(.) and unique('individual', .)"

 

General notes

To ensure consistency, a field patient.medical_record_number  is calculated based on the values obtained by either scanning or entering HCT AMRS ID. The patient.medical_record_number is not visible to the user. There is no checkdigit on this as it obtains values from fields with checkdigit validations.

 

There patient_identifier.identifier_type_id is preset to 8, there is no option for user to edit or view this field                    

                              

First Name

It is required

constraint="review('Given Name', .) and store('givenname', .)"

 

Middle Name

It is NOT required

constraint="review('Middle Name', .) and store('middlename', .)"

 

Family Name

constraint="review('Family Name', .) and store('familyname', .)"

It is required

 

Gender

It is required

constraint="review('Gender', .)"                  

                         

                                

Birthdate and age

  Age Entry Mode

  It is required

 

Age/Birthdate Estimated?

  It is required

 

Select Birthdate

   Shows up when the response to " Age Entry Mode" is Enter Full Birthdate

   The date cannot be less than the current date

   constraint=". &lt;= today()"

 

Number of Years  

   Shows up when the response to " Age Entry Mode" is Enter Age in Years or Months

   The age must be less or equal to 110 years but must be greater or equal to 0

   constraint=". &gt;= 0 and . &lt;= 110"

 

Number of Months

   Shows up when the response to " Age Entry Mode" is Enter Age in Years or Months  AND Number of Years is  less than 5

   The number of months entered must be between 0 and 11 months

   constraint=". &gt;= 0 and . &lt;= 11"

Notes: a am approximated age is calculated based on the date of birth and the current date. The approximated age is invisible to the user.

The calculation logic is shown below :

calculate="if(../age_type='birth_date', ((now()-../patient.birthdate) div 30.4375),

                                        (if(../age_in_months &gt;0, ((../age_in_years * 12)+../age_in_months), (../age_in_years * 12))))"           

 

 

Enter Phone Number

hint:If none, enter 0.

It is required

constraint="(. = '0' or regex(., '\d{8,12}')) and review('Phone Number', .) and review('Year of Birth', ../approximate_age)"                       

                      

Re-Enter Phone Number

hint:If none, enter 0.

A validation of the phone number entered above

Shows up when response to "Enter Phone Number" is not 0

It is required

constraint=". = ../patient.contact_phone_number"

                   

 

Individual Demographics

hint:Please write this demographics on the card and issue it out to the client.

Read only display

 

Marital Status

hint:Are you currently married or living with a partner?

It is required

Shows when age is equal/greater than 13 years

                       

Do you have a regular partner?  

  shows up when /form/hou is '1057^NEVER_MARRIED^99DCT'  or '1058^DIVORCED^99DCT' or '1056^SEPARATED^99DCT' or '1059^WIDOWED^99DCT'                    

  It is required                     

                       

Do you know the status of your partner?

  It is required

  Shows up when the response to "Do you have a regular partner? " is yes and approximate age is equal/greater than 13 years

 

Condom use?

Shows when age is equal/greater than 13 years

It is required

 

House Status

hint:A household resident is a person who is part of a household (including servants/employees).

It is required

 

Relation to Head of Household                        

It is required

constraint="not(selected(., 'self')) or (selected(.,'self') and selected(../house_status/value,'6141^HOUSEHOLD_RESIDENT^99DCT'))"

                       

Individual Economic Questions

 

Occupation

hint:Which occupation?

Shows when age is equal/greater than 13 years

 

Average income per month

Shows when age is equal/greater than 13 years

 

Wage hours in the Past Week

hint:Include for wage and business.

Required

Shows when age is equal/greater than 13 years

constraint=". &lt;= 168 and . &gt;= 0"

A week Must have  168 hours or below

 

Times Visited Clinic Due to Sickness in Last Month

hint:If none, enter 0.

Required

constraint=". &gt;= 0"

 

Amount of Money Spent on Medication in Last Month

hint:Value in Kshs

Required

constraint=". &gt;= 0"

Cannot be less than 0

                       

        

Pregnancy Questions

===================

Obviously Pregnant?

hint:Is the client pregnant?

Required

Shows when age is equal/greater than 13 years and patient is female

                        

Pregnancy Test Result:

Shows when patient is not Obviously Pregnant AND the last menstrual period date is greater than 35 days AND the last menstrual period date was less than 365 days and the client is HIV Positive

relevant="../../pregnancy_status/value='0'  

          and (today() - ../../last_menstrual_period_date/value &gt; 35

          and today() - ../../last_menstrual_period_date/value &lt; 365)

          and (../../test_outcome=' patient to a HIV Clinic' or ../../hiv_test_result_previously/value='703^POSITIVE^99DCT')"                         

                        

                        

Attending Antenatal Clinic

hint:Is the client enrolled in Antenatal Care Service?                       

Shows when patient is Obviously Pregnant  or  urine pregnancy test is POSITIVE                    

required

 

Issued with mosquito net

hint:Was the client issued with a mosquito net?

Shows when patient is Obviously Pregnant  or  urine pregnancy test is POSITIVE                    

required

 

Using mosquito net

hint:Was the client using a mosquito net?

Shows when patient is Obviously Pregnant  or  urine pregnancy test is POSITIVE                             

 

Mother Died is required

 

Mother HIV positive is required

 

Father Deceased is required

 

Father Hiv positive is required

General notes:

Child needs hiv test is a read only informational field that is displayed when:

     Shows when age is equal/greater than 13 years AND  mother is deceased or it is unknown whether the mother is deceased

     or  mother is hiv positive  or  mother's hiv status is UNKNOWN

     The values is field based on the following calculate logic:

         calculate="if(../../patient/approximate_age &lt; 156 and (../mother_deceased_coded/value='1065^YES^99DCT' or ../mother_deceased_coded/value='1067^UNKNOWN^99DCT' or

                                        ../mother_hiv_positive/value='1065^YES^99DCT' or ../mother_hiv_positive/value='1067^UNKNOWN^99DCT'), 'Needs Testing', 'Does Not Need Testing')"

 

Test Child Anyway

   Shows up when age is less than 13 years AND

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