Questions | Concept | |
|---|---|---|
What do you want to do? 🔘 Start ART 🔘 Substitute ART Regimen 🔘 Switch ART Regimen Line 🔘 Stop ART 🔘 Restart ART therapy | ||
Start ART | ||
Date of ART initiation ␣␣-␣␣-␣␣␣␣ 📆 | ||
Regimen line 🔽 🔽 | ||
Regimen 🔽 🔽 🔽 🔽 | ||
Switch ART Regimen Line | ||
Date regimen line switched ␣␣-␣␣-␣␣␣␣ 📆 | ||
Reason for switching regimen line 🔘 Virologic failure 🔘 Immunologic failure | ||
Regimen line 🔽 🔽 | ||
Regimen 🔽 🔽 🔽 🔽 | ||
Substitute ART Regimen | ||
Date regimen substituted ␣␣-␣␣-␣␣␣␣ 📆 | ||
Reason for substituting regimen 🔽 🔽 🔽 🔽 | ||
Regimen line 🔽 🔽 🔽 🔽 | ||
Regimen | ||
Stop ART - Refused treatment | ||
Date patient refused HIV care/treatment ␣␣-␣␣-␣␣␣␣ 📆 | ||
Reason for discontinuing service (text) __________________________________ | ||
Restart ART | ||
Date restarted ART ␣␣-␣␣-␣␣␣␣ 📆 | ||
Regimen line 🔽 🔽 🔽 🔽 | ||
Regimen 🔽 🔽 🔽 🔽 | ||
Reason for restarting ART __________________________________ | ||
Notes | ||
Notes __________________________________ | ||
General
Content
Integrations