Att 6_Screenshots _Data Abstraction Elements

Form Approved
OMB No. 0920-1080
Expiration Date: xx/xx/xxxx

HOPS Discovere Screen Shots

Log in Page for Discovere:

New Participant Screens:

Modify User Data Screens:

Search for Study Participant Screens:

Begin Data Entry (Data Collection Event) Screens:

Collapsed View of all Optional Forms for Data Entry:

Expanded View of all Optional Forms for Data Entry:

EACH Individual FORM Opened in Data Collection Event Screen:
Demographics Form:

Validation Error Message on Demographics Form:

Deleting Demograhics Form (or any form/entry):

This same message appears for any form that is removed from Discovere view/deleted. (Data is never
actually deleted and is maintained in background database.)

General Risk Factors Form:

Error message for Gen Risk Form:

Corrected and Saved General Risk Factors From:

Deleting item on any Form:

HIV Form:

Location of HIV Diagnosis Options in HIV Form:

AIDS Defining Illnesses Drop Down List on HIV Form:

Primary HIV Risk Factor Drop Down List

Reason No Date Entered in First ARV Use field drop down list on HIV
Form:

Validation Error Message for HIV Form:

HIV form completed:

Encounter Form:

Drop Down List for Encounter Type:

Primary Payor drop down list for Insurance:

Drop down list for Secondary Payor:

Error Message for Encounter Form:

Completed Encounter Screen for Initial Visit:

Diagnosis Screen:

Drop Down List for Diagnosis:

Error Message for Diagnosis Form:

Completed Diagnosis form for ONE diagnosis:

Treatment Form:

Drop Down List for Treatment Form:

Drop Down List for Strength and Units on Treatment Form:

Quantity Drop down list on Treatment Form.

Frequency of Administration drop down list on Treatment Form:

Route drop down list on Treatment Form:

Form of Treatment drop down list on the Treatment Form:

Down List for “Was this medication prescribed as part of a clinical trial”:

Drop Down List for “Was this a blinded or placebo controlled study”:

Drop down list for “What was the adherence to this drug”:

Drop Down List for “Reasons for Discontinuation” on Treatment Form?

Drop Down List for “Diagnosis link to treatment” on Treatment Form:

Error Messages on Treatment Form:

Completed Treatment Form for one treatment:

Prophylaxis Form:

“Reason for Discontinuation” Drop Down List on Prophylaxis Form:

Prophylaxis Type:

“Specific Prophylaxis” drop down menu:

“Target Disease 1, 2 and 3” Drop Down Screen (each is the same
although for 3 alternate entries if needed) on Prophylaxis Form:

Error messages on Prophylaxis Form:

Symptoms Form (this form is not typically used by most HOPS sites
currently):

Symptoms Drop Down Screen (sample):

Error message for Symptom Form:

Completed Symptom Form for one symptom:

Lab Forms:

Anal Cervical PAP Bx Lab Form:

Error Message on Anal Cervical PAP Bx Form:

Completed Anal Cervical PAP Bx Form:

BIA Form:

Error Message BIA Form:

Completed BIA Form:

Blood (Chemistry and CBC) Form:

Error Message on the Blood Form:

Completed Blood Form:

Cancer Form:

Error Message on Cancer Form:

Completed Cancer Form:

Cultures Form:

Error message on Cultures Form:

Completed Culture Form:

Disease Testing Form:

Error Message on Disease Testing Form:

Drug Levels Form:

Error Message on Drug Levels Form:

Completed Drug Levels Form:

Endo_Rheum Form:

Endo_Rheum Form:

Error Message on Endo_Rheum Form:

Completed Endo_Rheum Form:

HIV Form:

HIV Form:

Error Message on HIV Form:

Completed HIV Form:

ID Serology Form:

ID Serology Form:

Bottom of ID Serology Form

Error Message on ID Serology Form:

Completed ID Serology Lab Form
Plus a second order noted: “Question Mark” indicates an INCOMPLETE form DATE….This applies to all
lab forms:

Imaging Form:

Error Message on the Imaging Form:

Completed Imaging Form:

Other Biopsy Form:

Error Message on The Other Biopsy Form:

Completed Other Biopsy Form:

Procedures Form:

Procedures Form:

Error Messages on Procedures Form:

Completed Procedures Form:

Referrals_Misc Form:

Error Message on Referrals_Misc Form:

Completed Referrals_Misc Form:

STD Form:

Top Half of STD Form:

Error Message on the STD Form:

Completed STD Form:

“Surveys and Forms” Form:

Error Message on “Surveys and Forms” Form:

Completed “Surveys and Forms” Form:

Urine Form:

Urine Form:

Error Message on Urine Form:

Completed Urine Form:

Resistance Data is collected in three individual Forms (Genotype,
Phenotype, Trophile):

Genotype Form – Header Page:

Drop down List for Adequate Specimen for Genotype Form:

Drop Down List for Vendor for Genotype Form:

Error Message for Header Page of Genotype Form:

Completed Genotype Header Form:

PI Form within the Genotype Form:

Error Message on the PI form within the Genotype form:

Completed PI Form within the Genotype Form:

NRTI form within the Genotype Form:

Error Message within the Genotype Form:

Completed NRTI form within the Genotype Form:

NNRTI Form within the Genotype Form:

Error Message on the NNRTI form within the Genotype Form:

NNRTI form within the Genotype Form:

Inhibitors Form within the Genotype Form:

Error Message on the Inhibitors From within the Genotype Form:

Completed Inhibitors Form within the Genotype Form:

Completed Genotype Form (all 4 sections):

Phenotype Form:

Header Page within the Phenotype Form:

Drop Down List for Adequate Specimen on Phenotype Form:

Drop Down List for Tropism type on the Phenotype Header Form:

Drop Down List for Vendors on the Header page of the Phenotype
Form:

Error Message on the Header Page of the Phenotype Form:

Completed Header Page within the Phenotype Form:

Error Message on Header Page within the Phenotype Form:

PI form within the Phenotype Form:

NRTI form within the Phenotype Form:

NNRTI and Inhibitor form within the Phenotype form:

Completed Phenotype Form:

Trophile Form:

Error Message on Trophile Form:

Adequate specimen drop down box on Trophile Form:

Activity of CCR5 anticipated drop down box on Trophile Form:

Tropotype Result Drop Down Box in Trophile Form:

“Options” drop down box in Trophile Form:

Trophile form completed:

Completed Trophile From:

Hospital History Form:

Error message on Hospital History Form:

Drop Down List for Reason for Hospitalization History Form:

Up to EIGHT Reasons for Hospitaliztion Form Fields are available just
like the one above:

Completed Hospitalization Form:

Mortality Form:

Error Message on the Mortality Form:

Primary Cause of Death Drop Down Box for the Mortality Form ( to be
used on all causes of death and each of the Secondary Causes of Death :

Secondary Cause of Death on Mortality Form:

Drop Down Box for “All Source of Information” in Mortality Form:

Diagnosis existing at time of Death drop down box in Mortality Form: (5
options to select diagnosis existing at time of death):

Conditions existing at Time of Death drop down box:

Source of Information for Conditions Existing at Time of Death drop
down box:

Was the Patient Hospitalized at the Time of Death drop down box:

Completed Mortality Form: