Questions | Concept |
|---|---|
What do you want to do? 🔘 Start ART 🔘 Substitute ART Regimen 🔘 Switch ART Regimen Line 🔘 Stop ART 🔘 Restart ART therapy | 7557d77c-172b-4673-9335-67a38657dd01 |
Start ART | |
Date of ART initiation ␣␣-␣␣-␣␣␣␣ 📆 | 159599AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen line 🔽 Adult 1st line ARV regimen 🔽 Child 1st line ARV regimen | 164515AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen 🔽 ABC + 3TC + ATVr 🔽 🔽 🔽 | dfbe256e-30ba-4033-837a-2e8477f2e7cd |
Switch ART Regimen Line | |
Date regimen line switched ␣␣-␣␣-␣␣␣␣ 📆 | 164516AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Reason for switching regimen line 🔘 Virologic failure 🔘 Immunologic failure | 160568AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen line 🔽 Adult 2nd line ARV regimen 🔽 Child 2nd line ARV regimen | 164431AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen 🔽 🔽 🔽 🔽 | dfbe256e-30ba-4033-837a-2e8477f2e7cd |
Substitute ART Regimen | |
Date regimen substituted ␣␣-␣␣-␣␣␣␣ 📆 | 164431AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Reason for substituting regimen 🔽 New diagnosis of Tuberculosis 🔽 Currently pregnant 🔽 Medications unavailable 🔽 Toxicity, drug 🔽 Other non-coded | 160562AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen line 🔽 Adult 1st line ARV regimen 🔽 Adult 2nd line ARV regimen 🔽 Child 1st line ARV regimen 🔽 Child 2nd line ARV regimen | 164515AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen 🔽 🔽 🔽 🔽 | dfbe256e-30ba-4033-837a-2e8477f2e7cd |
Stop ART - Refused treatment | |
Date patient refused HIV care/treatment ␣␣-␣␣-␣␣␣␣ 📆 | 162572AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Reason for discontinuing service (text) __________________________________ | 163513AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Restart ART | |
Date restarted ART ␣␣-␣␣-␣␣␣␣ 📆 | 160738AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen line 🔽 Adult 1st line ARV regimen 🔽 Adult 2nd line ARV regimen 🔽 Child 1st line ARV regimen 🔽 Child 2nd line ARV regimen | 164515AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Regimen 🔽 🔽 🔽 🔽 | dfbe256e-30ba-4033-837a-2e8477f2e7cd |
Reason for restarting ART __________________________________ | 161011AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Notes | |
Notes __________________________________ | 160632AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
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