espen-mda-drug-receipt
type: Questionnaire
node role: treeRoot
resource.id:
  value: espen-mda-drug-receipt
resource.meta:
  meta.tag:
    index: 0
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-project-tag-cs
    coding.code:
      value: espen
    coding.display:
      value: ESPEN
domain resource.text:
  narrative.status:
    value: extensions
  narrative.div: Generated Narrative: Questionnaire espen-mda-drug-receipt Tag: ESPEN (Details: ICR Project Tag code espen = 'ESPEN') LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> EspenMDADrugReceipt 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). Questionnaire https://icr.healthcampaigns.org/Questionnaire/espen-mda-drug-receipt#0.1.0 #xD; p_recorder_id Select the recorder ID 0..1 string #xD; p_state Select State / Region / Province 1..1 string #xD; p_district Select District / LGA / County 1..1 string #xD; p_health_facility Enter the Health facility / Sub district 1..1 string #xD; p_disease Disease covered by the MDA 1..* choice Value Set: ICR NTD Disease #xD; p_medicine Select the medicine package 1..* choice Value Set: ICR MDA Medicine Package #xD; p_total_pzq Total Praziquantel received 1..1 integer Enable 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) #xD; p_total_alb Total Albendazole received 1..1 integer Enable 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) #xD; p_total_meb Total Mebendazole received 1..1 integer Enable When: p_medicine = MEB (mebendazole) (ICR MDA Medicine Package#meb) p_medicine = PZQ + MEB (ICR MDA Medicine Package#pzq-meb) #xD; p_total_ivm Total Ivermectin received 1..1 integer Enable 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) #x…
domain resource.contained: SupplyDelivery
  index: 0
  resource.id:
    value: sd-receipt-pzq
  resource.meta:
    meta.profile:
      value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
      index: 0
      link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
  domain resource.extension:
    index: 0
    extension.url:
      value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
    extension.value code:
      value: campaign
  supply delivery.status:
    value: completed
  supply delivery.supplied item:
    supply delivery.supplied item.quantity:
      quantity.unit:
        value: tablets
      quantity.system:
        value: http://unitsofmeasure.org
      quantity.code:
        value: {tbl}
    supply delivery.supplied item.item codeable concept:
      codeable concept.coding:
        index: 0
domain resource.contained: SupplyDelivery
  index: 1
  resource.id:
    value: sd-receipt-alb
  resource.meta:
    meta.profile:
      value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
      index: 0
      link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
  domain resource.extension:
    index: 0
    extension.url:
      value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
    extension.value code:
      value: campaign
  supply delivery.status:
    value: completed
  supply delivery.supplied item:
    supply delivery.supplied item.quantity:
      quantity.unit:
        value: tablets
      quantity.system:
        value: http://unitsofmeasure.org
      quantity.code:
        value: {tbl}
    supply delivery.supplied item.item codeable concept:
      codeable concept.coding:
        index: 0
domain resource.contained: SupplyDelivery
  index: 2
  resource.id:
    value: sd-receipt-meb
  resource.meta:
    meta.profile:
      value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
      index: 0
      link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
  domain resource.extension:
    index: 0
    extension.url:
      value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
    extension.value code:
      value: campaign
  supply delivery.status:
    value: completed
  supply delivery.supplied item:
    supply delivery.supplied item.quantity:
      quantity.unit:
        value: tablets
      quantity.system:
        value: http://unitsofmeasure.org
      quantity.code:
        value: {tbl}
    supply delivery.supplied item.item codeable concept:
      codeable concept.coding:
        index: 0
domain resource.contained: SupplyDelivery
  index: 3
  resource.id:
    value: sd-receipt-ivm
  resource.meta:
    meta.profile:
      value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
      index: 0
      link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
  domain resource.extension:
    index: 0
    extension.url:
      value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
    extension.value code:
      value: campaign
  supply delivery.status:
    value: completed
  supply delivery.supplied item:
    supply delivery.supplied item.quantity:
      quantity.unit:
        value: tablets
      quantity.system:
        value: http://unitsofmeasure.org
      quantity.code:
        value: {tbl}
    supply delivery.supplied item.item codeable concept:
      codeable concept.coding:
        index: 0
domain resource.contained: SupplyDelivery
  index: 4
  resource.id:
    value: sd-receipt-dec
  resource.meta:
    meta.profile:
      value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
      index: 0
      link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
  domain resource.extension:
    index: 0
    extension.url:
      value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
    extension.value code:
      value: campaign
  supply delivery.status:
    value: completed
  supply delivery.supplied item:
    supply delivery.supplied item.quantity:
      quantity.unit:
        value: tablets
      quantity.system:
        value: http://unitsofmeasure.org
      quantity.code:
        value: {tbl}
    supply delivery.supplied item.item codeable concept:
      codeable concept.coding:
        index: 0
domain resource.contained: SupplyDelivery
  index: 5
  resource.id:
    value: sd-receipt-azm-susp
  resource.meta:
    meta.profile:
      value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
      index: 0
      link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
  domain resource.extension:
    index: 0
    extension.url:
      value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
    extension.value code:
      value: campaign
  supply delivery.status:
    value: completed
  supply delivery.supplied item:
    supply delivery.supplied item.quantity:
      quantity.unit:
        value: liters
      quantity.system:
        value: http://unitsofmeasure.org
      quantity.code:
        value: L
    supply delivery.supplied item.item codeable concept:
      codeable concept.coding:
        index: 0
      codeable concept.text:
        value: azithromycin (suspension)
domain resource.contained: SupplyDelivery
  index: 6
  resource.id:
    value: sd-receipt-azm-tab
  resource.meta:
    meta.profile:
      value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
      index: 0
      link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
  domain resource.extension:
    index: 0
    extension.url:
      value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
    extension.value code:
      value: campaign

index: 0
extension.url:
  value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue
extension.value string:
  value: %resource.repeat(item).where(linkId='p_total_pzq').answer.value.first()

value: P02BA01

value: praziquantel

index: 0
extension.url:
  value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue
extension.value string:
  value: %resource.repeat(item).where(linkId='p_total_alb').answer.value.first()

value: P02CA03

value: albendazole

index: 0
extension.url:
  value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue
extension.value string:
  value: %resource.repeat(item).where(linkId='p_total_meb').answer.value.first()

value: P02CA01

value: mebendazole

index: 0
extension.url:
  value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue
extension.value string:
  value: %resource.repeat(item).where(linkId='p_total_ivm').answer.value.first()

value: P02CF01

value: ivermectin

index: 0
extension.url:
  value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue
extension.value string:
  value: %resource.repeat(item).where(linkId='p_total_dec').answer.value.first()

value: P02CB02

value: diethylcarbamazine

index: 0
extension.url:
  value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue
extension.value string:
  value: %resource.repeat(item).where(linkId='p_total_az_sus').answer.value.first()

value: J01FA10

value: azithromycin

value: completed

supply delivery.supplied item.quantity:
  quantity.value:
    element.extension:
      index: 0
      extension.url:
        value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtractValue
      extension.value string:
        value: %resource.repeat(item).where(linkId='p_total_az_tab').answer.value.first()
  quantity.unit:
    value: tablets
  quantity.system:
    value: http://unitsofmeasure.org
  quantity.code:
    value: {tbl}
supply delivery.supplied item.item codeable concept:
  codeable concept.coding:
    index: 0
    coding.system:
      value: http://www.whocc.no/atc
    coding.code:
      value: J01FA10
    coding.display:
      value: azithromycin
  codeable concept.text:
    value: azithromycin (tablets)

SupplyDelivery
index: 7
resource.id:
  value: sd-receipt-tetra
resource.meta:
  meta.profile:
    value: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
    index: 0
    link: https://icr.healthcampaigns.org/StructureDefinition/ICRSupplyDelivery
domain resource.extension:
  index: 0
  extension.url:
    value: https://icr.healthcampaigns.org/StructureDefinition/record-origin
  extension.value code:
    value: campaign
supply delivery.status:
  value: completed
supply delivery.supplied item:
  supply delivery.supplied item.quantity:
    quantity.value:
      element.extension:
        index: 0
    quantity.unit:
      value: tubes
    quantity.system:
      value: http://unitsofmeasure.org
    quantity.code:
      value: {tube}
  supply delivery.supplied item.item codeable concept:
    codeable concept.coding:
      index: 0
      coding.system:
        value: http://www.whocc.no/atc
      coding.code:
        value: S01AA09
      coding.display:
        value: tetracycline
    codeable concept.text:
      value: tetracycline (eye ointment)

value: %resource.repeat(item).where(linkId='p_total_tetra').answer.value.first()

value: 0.1.0

value: EspenMDADrugReceipt

value: active

value: false

value: Location
index: 0

value: 2026-08-07T08:41:18-04:00

value: UNICEF

index: 0
contact detail.name:
  value: UNICEF
contact detail.telecom:
  index: 0
  contact point.system:
    value: url
  contact point.value:
    value: https://www.unicef.org

value: 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).

index: 0
codeable concept.coding:
  index: 0
  coding.system:
    value: http://unstats.un.org/unsd/methods/m49/m49.htm
  coding.code:
    value: 001
  coding.display:
    value: World

index: 0
questionnaire.item.link id:
  value: p_recorder_id
questionnaire.item.text:
  value: Select the recorder ID
questionnaire.item.type:
  value: string

index: 1
questionnaire.item.link id:
  value: p_state
questionnaire.item.text:
  value: Select State / Region / Province
questionnaire.item.type:
  value: string
questionnaire.item.required:
  value: true

index: 2
questionnaire.item.link id:
  value: p_district
questionnaire.item.text:
  value: Select District / LGA / County
questionnaire.item.type:
  value: string
questionnaire.item.required:
  value: true

index: 3
questionnaire.item.link id:
  value: p_health_facility
questionnaire.item.text:
  value: Enter the Health facility / Sub district
questionnaire.item.type:
  value: string
questionnaire.item.required:
  value: true

index: 4
questionnaire.item.link id:
  value: p_disease
questionnaire.item.text:
  value: Disease covered by the MDA
questionnaire.item.type:
  value: choice
questionnaire.item.required:
  value: true
questionnaire.item.repeats:
  value: true
questionnaire.item.answer value set:
  value: https://icr.healthcampaigns.org/ValueSet/icr-ntd-disease-vs
  link: https://icr.healthcampaigns.org/ValueSet/icr-ntd-disease-vs

index: 5
questionnaire.item.link id:
  value: p_medicine
questionnaire.item.text:
  value: Select the medicine package
questionnaire.item.type:
  value: choice
questionnaire.item.required:
  value: true
questionnaire.item.repeats:
  value: true
questionnaire.item.answer value set:
  value: https://icr.healthcampaigns.org/ValueSet/icr-mda-medicine-package-vs
  link: https://icr.healthcampaigns.org/ValueSet/icr-mda-medicine-package-vs

index: 6
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-pzq
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_pzq
questionnaire.item.text:
  value: Total Praziquantel received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: pzq
questionnaire.item.enable when:
  index: 1
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: pzq-alb
questionnaire.item.enable when:
  index: 2
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: pzq-meb
questionnaire.item.enable behavior:
  value: any
questionnaire.item.required:
  value: true

index: 7
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-alb
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_alb
questionnaire.item.text:
  value: Total Albendazole received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: alb
questionnaire.item.enable when:
  index: 1
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: ivm-alb
questionnaire.item.enable when:
  index: 2
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: ivm-alb-dec
questionnaire.item.enable when:
  index: 3
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: pzq-alb
questionnaire.item.enable behavior:
  value: any
questionnaire.item.required:
  value: true

index: 8
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-meb
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_meb
questionnaire.item.text:
  value: Total Mebendazole received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: meb
questionnaire.item.enable when:
  index: 1
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: pzq-meb
questionnaire.item.enable behavior:
  value: any
questionnaire.item.required:
  value: true

index: 9
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-ivm
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_ivm
questionnaire.item.text:
  value: Total Ivermectin received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: ivm
questionnaire.item.enable when:
  index: 1
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: ivm-alb
questionnaire.item.enable when:
  index: 2
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: ivm-alb-dec
questionnaire.item.enable behavior:
  value: any
questionnaire.item.required:
  value: true

index: 10
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-dec
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_dec
questionnaire.item.text:
  value: Total Diethylcarbamazine received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: ivm-alb-dec
questionnaire.item.required:
  value: true

index: 11
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-azm-susp
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_az_sus
questionnaire.item.text:
  value: Total Azithromycin suspension (in l) received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: azm-susp
questionnaire.item.required:
  value: true

index: 12
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-azm-tab
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_az_tab
questionnaire.item.text:
  value: Total Azithromycin tablets received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: azm-tab
questionnaire.item.required:
  value: true

index: 13
element.extension:
  index: 0
  element.extension:
    index: 0
    extension.url:
      value: template
    extension.value reference:
      reference.reference:
        value: #sd-receipt-tetra
  extension.url:
    value: http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-templateExtract
questionnaire.item.link id:
  value: p_total_tetra
questionnaire.item.text:
  value: Total Tetracycline received
questionnaire.item.type:
  value: integer
questionnaire.item.enable when:
  index: 0
  questionnaire.item.enable when.question:
    value: p_medicine
  questionnaire.item.enable when.operator:
    value: =
  questionnaire.item.enable when.answer coding:
    coding.system:
      value: https://icr.healthcampaigns.org/CodeSystem/icr-mda-medicine-package-cs
    coding.code:
      value: tetra
questionnaire.item.required:
  value: true

index: 14
questionnaire.item.link id:
  value: p_add_note
questionnaire.item.text:
  value: Additional Note
questionnaire.item.type:
  value: text