Skip to content

Instantly share code, notes, and snippets.

@jacobmischka

jacobmischka/B3228EB4-E250-4AD2-9963-7A6D6E538D2C.json

Created March 16, 2017 16:36
Show Gist options
  • Save jacobmischka/d69648c82df786c56e0d4e424b7a9ef4 to your computer and use it in GitHub Desktop.
Save jacobmischka/d69648c82df786c56e0d4e424b7a9ef4 to your computer and use it in GitHub Desktop.
Download ZIP
Pediatric Short Form 8a Form
Raw
B3228EB4-E250-4AD2-9963-7A6D6E538D2C.json
{
"DateFinished": "",
"Items": [
{
"FormItemOID": "7E27B22F-02D5-49D2-87F5-0924E1C7AE4E",
"ID": "5018R1",
"Order": "1",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "3C0356BF-FC98-418E-88E0-C9497317121F",
"Description": "I felt accepted by other kids my age.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "7E27B22F-02D5-49D2-87F5-0924E1C7AE4E",
"ItemResponseOID": "8649D1C0-471B-4244-9D53-8DBE8F2E9536",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "7E27B22F-02D5-49D2-87F5-0924E1C7AE4E",
"ItemResponseOID": "9E6EC694-8EA1-4FBB-BEF5-53629CF2FB23",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "7E27B22F-02D5-49D2-87F5-0924E1C7AE4E",
"ItemResponseOID": "74652937-ABC0-4190-8356-FE00ACA38637",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "7E27B22F-02D5-49D2-87F5-0924E1C7AE4E",
"ItemResponseOID": "9585C2AC-E811-4065-B633-26B62498DBA8",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "7E27B22F-02D5-49D2-87F5-0924E1C7AE4E",
"ItemResponseOID": "A02F7291-2ECB-4AC8-B691-9534905B95A8",
"Value": "4",
"Position": "5"
}
]
}
]
},
{
"FormItemOID": "087815FE-3A25-47D6-ACE8-80A3B57ED4D6",
"ID": "5058R1",
"Order": "2",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "4E1F1730-D670-401F-A699-48B167C37FAA",
"Description": "I was able to count on my friends.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "087815FE-3A25-47D6-ACE8-80A3B57ED4D6",
"ItemResponseOID": "BE1B59E1-20DF-455A-AFA5-77D441A88F23",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "087815FE-3A25-47D6-ACE8-80A3B57ED4D6",
"ItemResponseOID": "22560E09-031B-4707-89CC-9EAB840BDAAA",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "087815FE-3A25-47D6-ACE8-80A3B57ED4D6",
"ItemResponseOID": "4777458E-EAB4-4F70-974C-3AFF6C5CC6C6",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "087815FE-3A25-47D6-ACE8-80A3B57ED4D6",
"ItemResponseOID": "3BE59E47-1173-456C-B477-BF3DEC3A9637",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "087815FE-3A25-47D6-ACE8-80A3B57ED4D6",
"ItemResponseOID": "1EF6DAC1-E55B-4896-BD7B-72754D30FCCB",
"Value": "4",
"Position": "5"
}
]
}
]
},
{
"FormItemOID": "4798421C-9146-483C-9FB8-F8B74DACFCE5",
"ID": "5056R1",
"Order": "3",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "EF36AAD0-E715-4177-BEAD-48D87DD348C4",
"Description": "I was able to talk about everything with my friends.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "4798421C-9146-483C-9FB8-F8B74DACFCE5",
"ItemResponseOID": "F517C328-D287-484D-9FAA-3CD785B7304D",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "4798421C-9146-483C-9FB8-F8B74DACFCE5",
"ItemResponseOID": "8EE183E0-75BC-41CA-9879-7B29FC814E2F",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "4798421C-9146-483C-9FB8-F8B74DACFCE5",
"ItemResponseOID": "D65D05B5-9628-42E1-BAF4-0F3A36CE7993",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "4798421C-9146-483C-9FB8-F8B74DACFCE5",
"ItemResponseOID": "82C7926A-101B-4CDB-8019-03E811F05669",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "4798421C-9146-483C-9FB8-F8B74DACFCE5",
"ItemResponseOID": "B2A052C4-8B49-4347-B48E-584095C1A095",
"Value": "4",
"Position": "5"
}
]
}
]
},
{
"FormItemOID": "23FDE391-6425-4780-A9B9-154B16112EC4",
"ID": "1147R1",
"Order": "4",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "F054AE99-4F71-486A-88DF-C5B9C6EEC798",
"Description": "I was good at making friends.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "23FDE391-6425-4780-A9B9-154B16112EC4",
"ItemResponseOID": "320DA72B-7D75-4B11-A627-5BBB0739B219",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "23FDE391-6425-4780-A9B9-154B16112EC4",
"ItemResponseOID": "20396F34-724B-40ED-93D0-2048B40218BD",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "23FDE391-6425-4780-A9B9-154B16112EC4",
"ItemResponseOID": "1C7249D5-AF22-4760-9CE5-A86F4F2338C7",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "23FDE391-6425-4780-A9B9-154B16112EC4",
"ItemResponseOID": "7A30D5BC-4EA7-4AF9-9939-ED3E239D6116",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "23FDE391-6425-4780-A9B9-154B16112EC4",
"ItemResponseOID": "06CA9564-0818-4601-8D49-7A1EF4B95D6A",
"Value": "4",
"Position": "5"
}
]
}
]
},
{
"FormItemOID": "6FD65002-7195-4515-B756-9A16F4BF28EB",
"ID": "5055R1",
"Order": "5",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "CE8087FA-B58E-4590-A3E4-6D64A2CCE224",
"Description": "My friends and I helped each other out.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "6FD65002-7195-4515-B756-9A16F4BF28EB",
"ItemResponseOID": "DBCA17B5-3E96-466A-B682-C32440080F19",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "6FD65002-7195-4515-B756-9A16F4BF28EB",
"ItemResponseOID": "1555A9A6-6B99-4E48-BFF0-8488AE4E32F7",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "6FD65002-7195-4515-B756-9A16F4BF28EB",
"ItemResponseOID": "4F005BB1-7F07-4649-AD48-24A3F85EC084",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "6FD65002-7195-4515-B756-9A16F4BF28EB",
"ItemResponseOID": "EFA460EB-368C-4CDF-9E5A-8C1C8AD61686",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "6FD65002-7195-4515-B756-9A16F4BF28EB",
"ItemResponseOID": "692AB777-FF7F-4DFD-80CC-F9DABBFC2D35",
"Value": "4",
"Position": "5"
}
]
}
]
},
{
"FormItemOID": "CE46AFFE-1337-4A29-9D07-7F1A06ECBE9D",
"ID": "233R2",
"Order": "6",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "23C636EE-E94E-4FD8-A9E1-DEBBED6AACEE",
"Description": "Other kids wanted to be my friend.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "CE46AFFE-1337-4A29-9D07-7F1A06ECBE9D",
"ItemResponseOID": "58C5ADDD-ACA6-4413-A135-15078FDB2556",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "CE46AFFE-1337-4A29-9D07-7F1A06ECBE9D",
"ItemResponseOID": "0809587C-E6F7-4DB2-A9A8-D714DAD98960",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "CE46AFFE-1337-4A29-9D07-7F1A06ECBE9D",
"ItemResponseOID": "D3395893-18C2-4D9C-BFDF-21F8B1E78FD7",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "CE46AFFE-1337-4A29-9D07-7F1A06ECBE9D",
"ItemResponseOID": "E7EA186F-F29C-417B-9EC6-632379EED14D",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "CE46AFFE-1337-4A29-9D07-7F1A06ECBE9D",
"ItemResponseOID": "A465C6A1-0E37-404F-8464-DFC5445D70B9",
"Value": "4",
"Position": "5"
}
]
}
]
},
{
"FormItemOID": "B28D665C-3E3E-4BBB-B4A6-0AE506CABA74",
"ID": "210R1",
"Order": "7",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "2993A392-D9ED-4713-9900-81947877A624",
"Description": "Other kids wanted to be with me.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "B28D665C-3E3E-4BBB-B4A6-0AE506CABA74",
"ItemResponseOID": "7BDF6F38-2863-4638-9389-07FAB9E41B46",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "B28D665C-3E3E-4BBB-B4A6-0AE506CABA74",
"ItemResponseOID": "B100A53A-33AE-47C9-B4B4-3BAE85D4D0A1",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "B28D665C-3E3E-4BBB-B4A6-0AE506CABA74",
"ItemResponseOID": "8CBD6373-3CBA-49D2-911E-B95BAD73C4D9",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "B28D665C-3E3E-4BBB-B4A6-0AE506CABA74",
"ItemResponseOID": "E10033A9-9446-4F21-AA49-E2A8BABFA4EB",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "B28D665C-3E3E-4BBB-B4A6-0AE506CABA74",
"ItemResponseOID": "314EF90E-D48A-45CE-B9BB-0E603A866846",
"Value": "4",
"Position": "5"
}
]
}
]
},
{
"FormItemOID": "6AF327BD-B221-488E-B842-FD5ECD738244",
"ID": "9020R1",
"Order": "8",
"ItemType": "",
"Elements": [
{
"ElementOID": "8AB8BA58-3BB0-40B6-B656-C24F1169069B",
"Description": "In the past 7 days",
"ElementOrder": "1"
},
{
"ElementOID": "27F6A82E-9B9B-46AF-B856-5E9B11769FDE",
"Description": "Other kids wanted to talk to me.",
"ElementOrder": "2"
},
{
"ElementOID": "C08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"Description": "ContainerForC08BDEB7-358E-4CB6-BD43-54A234D2D75A",
"ElementOrder": "3",
"Map": [
{
"ElementOID": "00483AA5-3F7A-47A7-85ED-B8158CAD3441",
"Description": "Never",
"FormItemOID": "6AF327BD-B221-488E-B842-FD5ECD738244",
"ItemResponseOID": "300A8FF3-FC47-409C-8725-336E2F3DB21E",
"Value": "0",
"Position": "1"
},
{
"ElementOID": "463E034D-37AD-4B0B-836D-E8739DD54B48",
"Description": "Almost Never",
"FormItemOID": "6AF327BD-B221-488E-B842-FD5ECD738244",
"ItemResponseOID": "2651A360-7288-4C4D-9FED-5BF88B72E873",
"Value": "1",
"Position": "2"
},
{
"ElementOID": "025469C3-CDE6-480C-99B9-33DF319C369A",
"Description": "Sometimes",
"FormItemOID": "6AF327BD-B221-488E-B842-FD5ECD738244",
"ItemResponseOID": "C05E0633-EC3C-40C0-A081-20064E7465CD",
"Value": "2",
"Position": "3"
},
{
"ElementOID": "2B092F99-1551-4871-8D42-6AD280AFEB33",
"Description": "Often",
"FormItemOID": "6AF327BD-B221-488E-B842-FD5ECD738244",
"ItemResponseOID": "33363DAA-7879-4A61-8EB1-E816B40F22A1",
"Value": "3",
"Position": "4"
},
{
"ElementOID": "DA3C4987-6335-448E-A95F-855BD4ED0276",
"Description": "Almost Always",
"FormItemOID": "6AF327BD-B221-488E-B842-FD5ECD738244",
"ItemResponseOID": "FB1F96A1-407A-43A8-9F82-535A703810A3",
"Value": "4",
"Position": "5"
}
]
}
]
}
]
}
Sign up for free to join this conversation on GitHub. Already have an account? Sign in to comment