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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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