Federal Ministry of Health Nigeria ScanForm
Programme
NG-HTS  |  HTS 001 Client Intake Form
Version v1.6 · Released 2026-05-14
Programme Metadata
Field Value
Ministry Federal Ministry of Health, Nigeria
Programme NG-HTS | HIV Testing Services
Form HTS 001 Client Intake Form
Version v1.6
Released 2026-05-14
Pages 2 (A4 portrait, double-sided)
Records per form 1 client visit
Last documentation update 2026-06-30
Note

This is live documentation. It is automatically regenerated each time modifications are made to the form or its processing pipeline. The content on every tab always reflects the currently deployed form version. Data is hosted and managed in compliance with Nigeria’s National Health Data Protection Act and PEPFAR data security requirements.

Form Overview

Form Purpose

The HTS 001 Client Intake Form is the primary client-level data capture instrument for Nigeria’s HIV Testing Services (HTS) programme. It records the complete clinical and counselling encounter for one client visit — from referral source and demographics through pre-test risk assessment, HIV test result, post-test counselling, and ancillary diagnostic results (syphilis, hepatitis B, hepatitis C, CD4, recency testing). The form is the foundational source record for PEPFAR MER indicators including HTS_TST, HTS_TST_POS, HTS_INDEX, and RTRI.

Context of the Form

The HTS 001 is deployed across all HIV testing service delivery points in Nigeria under the PEPFAR-supported national HTS programme, coordinated through the Federal Ministry of Health. It is used in facility-based settings (outpatient departments, wards, TB clinics, PMTCT, STI clinics, standalone HTS centres) and community-based settings (outreach, social network services, mobile testing). The form replaces or complements previous paper-based client intake registers with a ScanForm-digitised version that enables rapid, structured data capture without requiring real-time internet connectivity.

The form was designed in XLS-ScanForm specification and rendered as a two-page A4 ScanForm paper instrument. Version 1.6 was released on 2026-05-14 and is the currently deployed version.

Form in the System of Programme Tools

The HTS 001 sits at the centre of a suite of nine HTS forms deployed across the Nigeria programme. It links to companion forms through the shared Client Code identifier (pre-printed Batch–Bundle–Page–Check format):

Forms in the NG-HTS System
Form Name Relationship to HTS 001
HTS 001 Client Intake Form (this form) Origin — generates Client Code
HTS 002 HIV Request and Result Form Linked by Client Code — confirmatory test results
HTS 003 HIV Testing Worksheet Linked by Client Code — laboratory worksheet
HTS 004 HTS Register Monthly aggregate — cross-validates HTS 001 individual counts
HTS 005 Client Referral Form Linked by Client Code — post-test referral
HTS 006 Referral Register Aggregate referral tracking
HTS 007 Family Index Testing Form Linked by Index Client Code — contacts of positive clients
HTS 008 Partner Notification Services Linked by Client Code — partner notification
HTS 009 Risk Stratification Form Linked by Client Code — detailed risk assessment
HTS 010 HIV Self-Test Form Separate pathway — links via Client Code on follow-up
PMTCT 002 PMTCT HTS Register Shares pregnant client population — linked by Client Code

Form Structure at a Glance

Form Sections
Section Page Fields Key Variables
Facility & Visit Information Page 1 5 dateVisit, facilityName, facilityState, facilityLga
Referral, Setting & Modality Page 1 5 referredFrom, testingSetting, modality
Client Demographics Page 1 11 firstName, surname, age, sex, maritalStatus, educationId, employmentStatusId
Client Identification & Contact Page 1 7 clientCode, recency, phoneNumber, line, nearestLandmark, state, lga
Session Type & Index Testing Page 1 6 typeConsueling, previouslyTested, indexClient, relationWithIndexClient, indexClientCodeNew
Pregnancy & Breastfeeding Page 1 3 clientPregnant, breastFeedingUnder6, breastFeedingOver6
(A) Knowledge Assessment Page 1 8 previousTestedHIVNegative, timeLastHIVNegativeTestResult, knowledgeAssessment
(B) Personal HIV Risk Assessment Page 1 10 everHadSexualIntercourse … uprotectedSexWithCasualLastThreeMonths, riskAssessment
(C) TB & STI Screening Page 2 12 currentCough … lymphadenopathy, tbScreening, vaginalDischarge … complaintsGenitalSore, stiScreening
(D) Sex Partner Risk Page 2 8 sexPartnerHivPositive … sexPartnerUnprotectedAnal, sexPartnerRiskAssessment
Post-Test Counselling Page 2 21 hivTestResult, hivTestBefore, postTestCounseling, condomProvidedToClientCount, prepReferred
Recency, CD4, Syphilis, Hepatitis Page 2 6 recencyTest, cd4SemiQuantitative, cd4FlowCyteometry, syphilisTestResult, hepatitisBTestResult, hepatitisCTestResult
Provider Sign-off Page 2 7 completedBy, designation, sign, providerId, date

How Data Flows

Completed paper forms are photographed using the ScanForm mobile app. Images are transmitted to the ScanForm server where Optical Character Recognition (OCR) extracts digit boxes, letter boxes, and oval bubble selections. Extracted data passes through a dbt transformation pipeline (raw → clean → refinery) before powering client dashboards and feeding PEPFAR DATIM and Nigeria FMoH DHIS2.

  • Deployment: Pre-printed forms with unique Client Codes are distributed to HTS service delivery points in bound books. The Client Code is printed before distribution — providers must not alter it.
  • Completion: HTS counsellors complete the form during or immediately after the client encounter. Mandatory fields are marked with an asterisk (*) on the paper form.
  • Digitisation: A designated data clerk or the counsellor photographs each completed form page using the ScanForm app. In-phone automated validation fires immediately — the app prompts re-photography if OCR detects a required field is missing or a single-select question has multiple bubbles marked. Forms are uploaded at the end of each working day or when connectivity is available.
  • Verification: OCR results with low confidence are queued for human verifier review in the ScanForm web interface. Fields where OCR is certain are hidden from the queue automatically.
  • Pipeline: Verified data flows through the ng_hiv dbt project (staging → intermediary → refinery) and is available in dashboards and reports within 24 hours of upload.
📄 Paper Form → 📷 Photographed → 🔍 OCR + In-Phone Validation → 👁 Human Verification → ⚙️ dbt Pipeline → 📊 Dashboard / DHIS2 / DATIM

Key Facts

Form at a Glance
Metric Value
Total variables 93
Mandatory fields (marked * on form) 14
OCR-processed fields 86
Handwritten fields (not OCR extracted) 7
Client-side validation checks 73
Distinct OCR models used 13
Scored assessment sections 4 (Knowledge, Personal Risk, TB Screening, STI Screening, Sex Partner Risk)
PEPFAR MER indicators supported HTS_TST, HTS_TST_POS, HTS_INDEX, RTRI, PrEP_NEW
Physical format 2-page A4 portrait · 1 client visit per form

How to Use This Documentation

Tip

Navigate using the tabs at the top of this page. Each tab covers a different aspect of the form:

  • Data Dictionary — all form fields, their types, formats, required status, OCR models, identifier linkage rules, and the answer options for each select-one field
  • Data Quality Assessment — client-side validation rules applied on the device before submission, and server-side DQA checks applied after upload to the central server, with severity classifications and indicator impact
  • Indicators — formal definitions of all reported indicators derived from this form, including PEPFAR MER indicators and programme-specific custom indicators, with numerators, denominators, disaggregations, and source variable names

For field staff and data managers: If you find a discrepancy between what is printed on the physical form and what is described in this documentation, the physical form takes precedence — report the discrepancy to your data supervisor so this documentation can be updated.

For programme analysts: All variable names in this documentation match the column names in the ng_hiv_refinery__hts_001_client_intake and ng_hiv_refinery__hts_001_client_intake__no_pii dbt refinery tables. The no-PII variant excludes firstName, otherName, surname, phoneNumber, city, countryId, line, postalCode, and nearestLandmark.

Generated automatically from HTS 001 Client Intake Form v1.6 source files. Last updated: 2026-06-30.