Syphilis AOE Questions: The following information is to be presented on the screen for single-entry when the patient/participant has a positive/reactive Syphilis test result. (text below is meant as a placeholder until final confirmation is received from DHSP)
Syphilis result
[Radio button] Positive
[Radio button] Negative
[Radio button] Inconclusive
Has the patient been told they have syphilis before?
[Radio button] Yes
[Radio button] No
[Radio button] Prefer not to say
Is the patient currently experiencing any symptoms?
[Radio button] Yes
[Radio button] No
Which symptoms are they experiencing?
[checkbox] Genital sore/lesion
[checkbox] Anal sore/lesion
[checkbox] Sore(s) in mouth/lips
[checkbox] Body Rash
[checkbox] Palmar (hand)/plantar (foot) rash
[checkbox] Flat white warts
[checkbox] Hearing loss
[checkbox] Blurred vision
[checkbox] Patchy hair loss
Date of symptom onset
MM/DD/YYYY
What is the gender of their sexual partners? (Select all that apply)
[checkbox] Female
[checkbox] Male
[checkbox] Transwoman
[checkbox] Transman
[checkbox] Nonbinary or gender non-conforming
[checkbox] Gender identity not listed here
[checkbox] Prefer not to answer
Is the patient pregnant?
[Radio button] Yes
[Radio button] No
[Radio button] Prefer not to say
[Button] Submit results
Description
Action Requested
Acceptance Criteria
Additional Context
Syphilis AOE Questions: The following information is to be presented on the screen for single-entry when the patient/participant has a positive/reactive Syphilis test result. (text below is meant as a placeholder until final confirmation is received from DHSP)