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@ckarnell
Created August 1, 2017 18:15
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{
"forms": [
{
"title": "DEMOGRAPHICS",
"label": "DEMOGRAPHICS",
"name": "DEMOGRAPHICS",
"formSections": [
{
"formFields": [
{
"name": "BRTHDAT",
"question": "Date of Birth",
"type": "DOB"
},
{
"name": "AGE",
"question": "Age at screening?",
"type": "NUMBER"
},
{
"name": "SEX",
"question": "Sex",
"type": "RADIO",
"optionChoices": [
{
"label": "Male",
"value": "MALE"
},
{
"label": "Female",
"value": "FEMALE"
}
]
},
{
"name": "RACE",
"question": "Race",
"type": "MULTI_SELECT",
"optionChoices": [
{
"label": "Asian",
"value": "ASIAN"
},
{
"label": "Black or African American",
"value": "BLACK_OR_AFRICAN_AMERICAN"
},
{
"label": "Native Hawaiian or Other Pacific Islander",
"value": "NATIVE_HAWAIIAN_OR_OTHER_PACIFIC_ISLANDER"
},
{
"label": "White or Caucasian",
"value": "WHITE"
},
{
"label": "Unknown or Not Reported",
"value": "NOT_REPORTED"
},
{
"label": "Other race (specify)",
"value": "RACEOTH",
"acceptsInput": true
}
]
},
{
"name": "ETHNIC",
"question": "Ethnicity",
"type": "RADIO",
"optionChoices": [
{
"label": "Hispanic or Latino",
"value": "HISPANIC OR LATINO"
},
{
"label": "Non-Hispanic or Latino",
"value": "NOT_HISPANIC_OR_LATINO"
},
{
"label": "Unknown",
"value": "UNKNOWN"
},
{
"label": "Not Reported",
"value": "NOT_REPORTED"
}
]
}
]
}
]
},
{
"title": "SUBSTANCE USE",
"label": "SUBSTANCE USE",
"name": "SUCAT",
"formSections": [
{
"title": "Alcohol Use",
"name": "ALCOHOL",
"formFields": [
{
"name": "SUNCF",
"question": "Alcohol Use",
"type": "RADIO",
"optionChoices": [
{
"label": "Never",
"value": "NEVER"
},
{
"label": "Former",
"value": "FORMER"
},
{
"label": "Current",
"value": "CURRENT"
}
]
},
{
"name": "SUENDAT",
"question": "Stop date",
"renderIf": [
"==", "{{ SUCAT.ALCOHOL.SUNCF }}", "FORMER"
],
"type": "DATE"
},
{
"name": "SUDSTXT",
"question": "How many drinks?",
"renderIf": [
"==", "{{ SUCAT.ALCOHOL.SUNCF }}", "CURRENT"
],
"type": "RADIO",
"optionChoices": [
{
"label": "<1",
"value": "<1"
},
{
"label": "1-2",
"value": "1-2"
},
{
"label": ">2-3",
"value": ">2-3"
},
{
"label": ">3-4",
"value": ">3-4"
},
{
"label": "4-5",
"value": "4-5"
},
{
"label": ">5",
"value": ">5"
}
]
},
{
"name": "SUDOSFRQ",
"question": "How often?",
"type": "RADIO",
"renderIf": [
"==", "{{ SUCAT.ALCOHOL.SUNCF }}", "CURRENT"
],
"optionChoices": [
{
"label": "Per day",
"value": "PER_DAY"
},
{
"label": "Per week",
"value": "PER_WEEK"
},
{
"label": "Occasionally",
"value": "OCCASIONALLY"
}
]
}
]
},
{
"title": "Caffeine Use",
"name": "CAFFEINE",
"formFields": [
{
"name": "SUNCF",
"question": "Caffeine Use",
"type": "RADIO",
"optionChoices": [
{
"label": "Never",
"value": "NEVER"
},
{
"label": "Former",
"value": "FORMER"
},
{
"label": "Current",
"value": "CURRENT"
}
]
},
{
"name": "SUENDAT",
"question": "Stop date",
"renderIf": [
"==", "{{ SUCAT.CAFFEINE.SUNCF }}", "FORMER"
],
"type": "DATE"
},
{
"name": "SUDSTXT",
"question": "How many drinks?",
"type": "RADIO",
"optionChoices": [
{
"label": "<1",
"value": "<1"
},
{
"label": "1-2",
"value": "1-2"
},
{
"label": ">2-3",
"value": ">2-3"
},
{
"label": ">3-4",
"value": ">3-4"
},
{
"label": "4-5",
"value": "4-5"
},
{
"label": ">5",
"value": ">5"
}
]
},
{
"name": "SUDOSFRQ",
"question": "How often?",
"type": "RADIO",
"renderIf": [
"==", "{{ SUCAT.CAFFEINE.SUNCF }}", "CURRENT"
],
"optionChoices": [
{
"label": "Per day",
"value": "PER_DAY"
},
{
"label": "Per week",
"value": "PER_WEEK"
},
{
"label": "Occasionally",
"value": "OCCASIONALLY"
}
]
}
]
}
]
}
]
}
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