{ "resourceType" : "Questionnaire", "id" : "espen-mda-drug-receipt", "meta" : { "tag" : [{ "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-project-tag-cs", "code" : "espen", "display" : "ESPEN" }] }, "text" : { "status" : "extensions", "div" : "

Generated Narrative: Questionnaire espen-mda-drug-receipt

Tag: ESPEN (Details: ICR Project Tag code espen = 'ESPEN')

\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
LinkIDTextCardinalityTypeDescription & Constraints\"doco\"
\".\"\".\" EspenMDADrugReceiptESPEN MDA demo Form 2 (medicine receipt at health facility): disease and medicine-package scope, per-medicine received totals. Template-based extraction: one ICRSupplyDelivery per answered medicine total (espen-forms).Questionnairehttps://icr.healthcampaigns.org/Questionnaire/espen-mda-drug-receipt#0.1.0
\".\"\".\"\".\" p_recorder_idSelect the recorder ID0..1string
\".\"\".\"\".\" p_stateSelect State / Region / Province1..1string
\".\"\".\"\".\" p_districtSelect District / LGA / County1..1string
\".\"\".\"\".\" p_health_facilityEnter the Health facility / Sub district1..1string
\".\"\".\"\".\" p_diseaseDisease covered by the MDA1..*choiceValue Set: ICR NTD Disease
\".\"\".\"\".\" p_medicineSelect the medicine package1..*choiceValue Set: ICR MDA Medicine Package
\".\"\".\"\".\" p_total_pzqTotal Praziquantel received1..1integerEnable When:
  • p_medicine = PZQ (praziquantel) (ICR MDA Medicine Package#pzq)
  • p_medicine = PZQ + ALB (ICR MDA Medicine Package#pzq-alb)
  • p_medicine = PZQ + MEB (ICR MDA Medicine Package#pzq-meb)
\".\"\".\"\".\" p_total_albTotal Albendazole received1..1integerEnable When:
  • p_medicine = ALB (albendazole) (ICR MDA Medicine Package#alb)
  • p_medicine = IVM + ALB (ICR MDA Medicine Package#ivm-alb)
  • p_medicine = IVM + ALB + DEC (ICR MDA Medicine Package#ivm-alb-dec)
  • p_medicine = PZQ + ALB (ICR MDA Medicine Package#pzq-alb)
\".\"\".\"\".\" p_total_mebTotal Mebendazole received1..1integerEnable When:
  • p_medicine = MEB (mebendazole) (ICR MDA Medicine Package#meb)
  • p_medicine = PZQ + MEB (ICR MDA Medicine Package#pzq-meb)
\".\"\".\"\".\" p_total_ivmTotal Ivermectin received1..1integerEnable When:
  • p_medicine = IVM (ivermectin) (ICR MDA Medicine Package#ivm)
  • p_medicine = IVM + ALB (ICR MDA Medicine Package#ivm-alb)
  • p_medicine = IVM + ALB + DEC (ICR MDA Medicine Package#ivm-alb-dec)
\".\"\".\"\".\" p_total_decTotal Diethylcarbamazine received1..1integerEnable When: p_medicine = IVM + ALB + DEC (ICR MDA Medicine Package#ivm-alb-dec)
\".\"\".\"\".\" p_total_az_susTotal Azithromycin suspension (in l) received1..1integerEnable When: p_medicine = AZM suspension (azithromycin) (ICR MDA Medicine Package#azm-susp)
\".\"\".\"\".\" p_total_az_tabTotal Azithromycin tablets received1..1integerEnable When: p_medicine = AZM tablets (azithromycin) (ICR MDA Medicine Package#azm-tab)
\".\"\".\"\".\" p_total_tetraTotal Tetracycline received1..1integerEnable When: p_medicine = TETRA (tetracycline eye ointment) (ICR MDA Medicine Package#tetra)
\".\"\".\"\".\" p_add_noteAdditional Note0..1text

\"doco\" Documentation for this format

Contained Resources

SupplyDelivery #sd-receipt-pzq

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* tablets (Details: UCUM code{tbl} = '{tbl}')praziquantel

SupplyDelivery #sd-receipt-alb

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* tablets (Details: UCUM code{tbl} = '{tbl}')albendazole

SupplyDelivery #sd-receipt-meb

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* tablets (Details: UCUM code{tbl} = '{tbl}')mebendazole

SupplyDelivery #sd-receipt-ivm

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* tablets (Details: UCUM code{tbl} = '{tbl}')ivermectin

SupplyDelivery #sd-receipt-dec

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* tablets (Details: UCUM code{tbl} = '{tbl}')diethylcarbamazine

SupplyDelivery #sd-receipt-azm-susp

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* liters (Details: UCUM codeL = 'L')azithromycin (suspension)

SupplyDelivery #sd-receipt-azm-tab

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* tablets (Details: UCUM code{tbl} = '{tbl}')azithromycin (tablets)

SupplyDelivery #sd-receipt-tetra

Profile: ICR Supply Delivery

Record Origin: campaign

status: Delivered

SuppliedItems

-QuantityItem[x]
* tubes (Details: UCUM code{tube} = '{tube}')tetracycline (eye ointment)
" }, "contained" : [{ "resourceType" : "SupplyDelivery", "id" : "sd-receipt-pzq", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_pzq').answer.value.first()" }] }, "unit" : "tablets", "system" : "http://unitsofmeasure.org", "code" : "{tbl}" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "P02BA01", "display" : "praziquantel" }] } } }, { "resourceType" : "SupplyDelivery", "id" : "sd-receipt-alb", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_alb').answer.value.first()" }] }, "unit" : "tablets", "system" : "http://unitsofmeasure.org", "code" : "{tbl}" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "P02CA03", "display" : "albendazole" }] } } }, { "resourceType" : "SupplyDelivery", "id" : "sd-receipt-meb", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_meb').answer.value.first()" }] }, "unit" : "tablets", "system" : "http://unitsofmeasure.org", "code" : "{tbl}" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "P02CA01", "display" : "mebendazole" }] } } }, { "resourceType" : "SupplyDelivery", "id" : "sd-receipt-ivm", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_ivm').answer.value.first()" }] }, "unit" : "tablets", "system" : "http://unitsofmeasure.org", "code" : "{tbl}" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "P02CF01", "display" : "ivermectin" }] } } }, { "resourceType" : "SupplyDelivery", "id" : "sd-receipt-dec", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_dec').answer.value.first()" }] }, "unit" : "tablets", "system" : "http://unitsofmeasure.org", "code" : "{tbl}" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "P02CB02", "display" : "diethylcarbamazine" }] } } }, { "resourceType" : "SupplyDelivery", "id" : "sd-receipt-azm-susp", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_az_sus').answer.value.first()" }] }, "unit" : "liters", "system" : "http://unitsofmeasure.org", "code" : "L" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "J01FA10", "display" : "azithromycin" }], "text" : "azithromycin (suspension)" } } }, { "resourceType" : "SupplyDelivery", "id" : "sd-receipt-azm-tab", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_az_tab').answer.value.first()" }] }, "unit" : "tablets", "system" : "http://unitsofmeasure.org", "code" : "{tbl}" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "J01FA10", "display" : "azithromycin" }], "text" : "azithromycin (tablets)" } } }, { "resourceType" : "SupplyDelivery", "id" : "sd-receipt-tetra", "meta" : { "profile" : ["https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery"] }, "extension" : [{ "url" : "https://icr.healthcampaigns.org/StructureDefinition/record-origin", "valueCode" : "campaign" }], "status" : "completed", "suppliedItem" : { "quantity" : { "_value" : { "extension" : [{ "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue", "valueString" : "%resource.repeat(item).where(linkId='p_total_tetra').answer.value.first()" }] }, "unit" : "tubes", "system" : "http://unitsofmeasure.org", "code" : "{tube}" }, "itemCodeableConcept" : { "coding" : [{ "system" : "http://www.whocc.no/atc", "code" : "S01AA09", "display" : "tetracycline" }], "text" : "tetracycline (eye ointment)" } } }], "url" : "https://icr.healthcampaigns.org/Questionnaire/espen-mda-drug-receipt", "version" : "0.1.0", "name" : "EspenMDADrugReceipt", "status" : "active", "experimental" : false, "subjectType" : ["Location"], "date" : "2026-07-05T20:56:14+00:00", "publisher" : "UNICEF", "contact" : [{ "name" : "UNICEF", "telecom" : [{ "system" : "url", "value" : "https://www.unicef.org" }] }], "description" : "ESPEN MDA demo Form 2 (medicine receipt at health facility): disease and medicine-package scope, per-medicine received totals. Template-based extraction: one ICRSupplyDelivery per answered medicine total (espen-forms).", "jurisdiction" : [{ "coding" : [{ "system" : "http://unstats.un.org/unsd/methods/m49/m49.htm", "code" : "001", "display" : "World" }] }], "item" : [{ "linkId" : "p_recorder_id", "text" : "Select the recorder ID", "type" : "string" }, { "linkId" : "p_state", "text" : "Select State / Region / Province", "type" : "string", "required" : true }, { "linkId" : "p_district", "text" : "Select District / LGA / County", "type" : "string", "required" : true }, { "linkId" : "p_health_facility", "text" : "Enter the Health facility / Sub district", "type" : "string", "required" : true }, { "linkId" : "p_disease", "text" : "Disease covered by the MDA", "type" : "choice", "required" : true, "repeats" : true, "answerValueSet" : "https://icr.healthcampaigns.org/ValueSet/icr-ntd-disease-vs" }, { "linkId" : "p_medicine", "text" : "Select the medicine package", "type" : "choice", "required" : true, "repeats" : true, "answerValueSet" : "https://icr.healthcampaigns.org/ValueSet/icr-mda-medicine-package-vs" }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-pzq" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_pzq", "text" : "Total Praziquantel received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "pzq" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "pzq-alb" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "pzq-meb" } }], "enableBehavior" : "any", "required" : true }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-alb" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_alb", "text" : "Total Albendazole received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "alb" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "ivm-alb" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "ivm-alb-dec" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "pzq-alb" } }], "enableBehavior" : "any", "required" : true }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-meb" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_meb", "text" : "Total Mebendazole received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "meb" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "pzq-meb" } }], "enableBehavior" : "any", "required" : true }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-ivm" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_ivm", "text" : "Total Ivermectin received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "ivm" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "ivm-alb" } }, { "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "ivm-alb-dec" } }], "enableBehavior" : "any", "required" : true }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-dec" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_dec", "text" : "Total Diethylcarbamazine received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "ivm-alb-dec" } }], "required" : true }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-azm-susp" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_az_sus", "text" : "Total Azithromycin suspension (in l) received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "azm-susp" } }], "required" : true }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-azm-tab" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_az_tab", "text" : "Total Azithromycin tablets received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "azm-tab" } }], "required" : true }, { "extension" : [{ "extension" : [{ "url" : "template", "valueReference" : { "reference" : "#sd-receipt-tetra" } }], "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract" }], "linkId" : "p_total_tetra", "text" : "Total Tetracycline received", "type" : "integer", "enableWhen" : [{ "question" : "p_medicine", "operator" : "=", "answerCoding" : { "system" : "https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs", "code" : "tetra" } }], "required" : true }, { "linkId" : "p_add_note", "text" : "Additional Note", "type" : "text" }] }