From df01fa143cba99e00628f7229003913e9cd97cb7 Mon Sep 17 00:00:00 2001 From: Pauline Conde Date: Wed, 20 Nov 2024 19:13:34 +0000 Subject: [PATCH] Update Questionnaire mediterranean_diet_adherence/mediterranean_diet_adherence_armt.json --- .../mediterranean_diet_adherence_armt.json | 38401 +++++++++++++++- 1 file changed, 38233 insertions(+), 168 deletions(-) diff --git a/questionnaires/mediterranean_diet_adherence/mediterranean_diet_adherence_armt.json b/questionnaires/mediterranean_diet_adherence/mediterranean_diet_adherence_armt.json index f5720d94..b4cf0476 100644 --- a/questionnaires/mediterranean_diet_adherence/mediterranean_diet_adherence_armt.json +++ b/questionnaires/mediterranean_diet_adherence/mediterranean_diet_adherence_armt.json @@ -1,18 +1,37941 @@ [ { - "field_name": "med_1", - "form_name": "mediterranean_diet_adherence", + "field_name": "record_id", + "form_name": "esm", "section_header": "", + "field_type": "text", + "field_label": "Record ID", + 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+ "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm6", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_questionnaire", + "form_name": "esm", + "section_header": "", + "field_type": "range", + "field_label": "Filling out the questionnaire has influenced my mood today", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm6", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "pdq_1", + "form_name": "perceived_deficits_questionnaire", + "section_header": "During the past 7-days, how often did you:", + "field_type": "radio", + "field_label": "Have trouble getting things organised?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never in the past 7 days" + }, + { + "code": "1", + "label": "Rarely (once or twice)" + }, + { + "code": "2", + "label": "Sometimes (3-5 times)" + }, + { + "code": "3", + "label": "Often (about once a day)" + }, + { + "code": "4", + "label": "Very often (more than once a day)" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "pdq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pdq_2", + "form_name": "perceived_deficits_questionnaire", + "section_header": "", + "field_type": "radio", + "field_label": "Have trouble concentrating on what you were reading?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never in the past 7 days" + }, + { + "code": "1", + "label": "Rarely (once or twice)" + }, + { + "code": "2", + "label": "Sometimes (3-5 times)" + }, + { + "code": "3", + "label": "Often (about once a day)" + }, + { + "code": "4", + "label": "Very often (more than once a day)" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "pdq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pdq_3", + "form_name": "perceived_deficits_questionnaire", + "section_header": "", + "field_type": "radio", + "field_label": "Forget the date unless you looked it up?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never in the past 7 days" + }, + { + "code": "1", + "label": "Rarely (once or twice)" + }, + { + "code": "2", + "label": "Sometimes (3-5 times)" + }, + { + "code": "3", + "label": "Often (about once a day)" + }, + { + "code": "4", + "label": "Very often (more than once a day)" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "pdq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pdq_4", + "form_name": "perceived_deficits_questionnaire", + "section_header": "", + "field_type": "radio", + "field_label": "Forget what you talked about after a telephone conversation?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never in the past 7 days" + }, + { + "code": "1", + "label": "Rarely (once or twice)" + }, + { + "code": "2", + "label": "Sometimes (3-5 times)" + }, + { + "code": "3", + "label": "Often (about once a day)" + }, + { + "code": "4", + "label": "Very often (more than once a day)" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "pdq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pdq_5", + "form_name": "perceived_deficits_questionnaire", + "section_header": "", + "field_type": "radio", + "field_label": "Feel like your mind went totally blank?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never in the past 7 days" + }, + { + "code": "1", + "label": "Rarely (once or twice)" + }, + { + "code": "2", + "label": "Sometimes (3-5 times)" + }, + { + "code": "3", + "label": "Often (about once a day)" + }, + { + "code": "4", + "label": "Very often (more than once a day)" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "pdq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_1", + "form_name": "phq8", + "section_header": "Over the past two weeks, how often have you been bothered by any of the following problems ", + "field_type": "radio", + "field_label": "1. Little interest or pleasure in doing things?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_2", + "form_name": "phq8", + "section_header": "", + "field_type": "radio", + "field_label": "2. Feeling down, depressed, or hopeless?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_3", + "form_name": "phq8", + "section_header": "", + "field_type": "radio", + "field_label": "3. Trouble falling asleep or staying asleep, or sleeping too much?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_4", + "form_name": "phq8", + "section_header": "", + "field_type": "radio", + "field_label": "4. Feeling tired or having little energy?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_5", + "form_name": "phq8", + "section_header": "", + "field_type": "radio", + "field_label": "5. Poor appetite or over eating", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_6", + "form_name": "phq8", + "section_header": "", + "field_type": "radio", + "field_label": "6. Feeling bad about yourself, or that you are a failure or have let yourself or your family down?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_7", + "form_name": "phq8", + "section_header": "", + "field_type": "radio", + "field_label": "7. Trouble concentrating on things such as reading the newspaper or watching television?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq8_8", + "form_name": "phq8", + "section_header": "", + "field_type": "radio", + "field_label": "8. Moving or speaking so slowly that other people have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq8", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_1", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "1. On the whole, I am satisfied with myself", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_2", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "2. At times, I think I am no good at all", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_3", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "3. I feel that I have a number of good qualities", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_4", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "4. I am able to do things as well as most other people", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_5", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "5. I feel I do not have much to be proud of", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_6", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "6. I certainly feel useless at times", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_7", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "7. I feel that I'm a person of worth, at least on an equal plane with others.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_8", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "8. I wish I could have more respect for myself", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_9", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "9. All in all, I am inclined to feel that I am a failure", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rses_10", + "form_name": "rses", + "section_header": "", + "field_type": "radio", + "field_label": "10. I take a positive attitude towards myself.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Strongly disagree" + }, + { + "code": "1", + "label": "Disagree" + }, + { + "code": "2", + "label": "Agree" + }, + { + "code": "3", + "label": "Strongly agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rses", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pdds", + "form_name": "patient_determined_disease_step", + "section_header": "Instructions: Please read the choices listed below and choose the one that best describes your own situation. This scale focuses mainly on how well you walk. You might not find a description that reflects your condition exactly, but please mark the one category that describes your situation the closest.", + "field_type": "range-info", + "field_label": "Which category describes your walking situation closest?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Normal: I may have some mild symptoms, mostly sensory due to MS but they do not limit my activity. If I do have an attack, I return to normal when the attack has passed." + }, + { + "code": "1", + "label": "Mild Disability: I have some noticeable symptoms from my MS but they are minor and have only a small effect on my lifestyle." + }, + { + "code": "2", + "label": "Moderate Disability: I do not have any limitations in my walking ability. However, I do have significant problems due to MS that limit daily activities in other ways." + }, + { + "code": "3", + "label": "Gait Disability: MS does interfere with my activities, especially my walking. I can work a full day, but athletic or physically demanding activities are more difficult than they used to be. I usually do not need a cane or other assistance to walk, but I might need some assistance during an attack." + }, + { + "code": "4", + "label": "Early Cane: I use a cane or a single crutch or some other form of support (such as touching a wall or leaning on someones arm) for walking all the time or part of the time, especially when walking outside. I think I can walk 25 feet in 20 seconds without a cane or crutch. I always need some assistance (cane or crutch) if I want to walk as far as 3 blocks." + }, + { + "code": "5", + "label": "Late Cane: To be able to walk 25 feet, I have to have a cane, crutch or someone to hold onto. I can get around the house or other buildings by holding onto furniture or touching the wallsfor support. I may use a scooter or wheelchair if I want to go greater distances." + }, + { + "code": "6", + "label": "Bilateral Support: To be able to walk as far as 25 feet I must have 2 canes or crutches or a walker. I may use a scooter or wheelchair for longer distances." + }, + { + "code": "7", + "label": "Wheelchair / Scooter: My main form of mobility is a wheelchair. I may be able to stand and/or take one or two steps, but I cannot walk 25 feet, even with crutches or a walker." + }, + { + "code": "8", + "label": "Bedridden: Unable to sit in a wheelchair for more than one hour" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "pdds", + "matrix_ranking": "y", + "field_annotation": "range-info-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_sleep_well_v2", + "form_name": "esm28q", + "section_header": "", + "field_type": "range", + "field_label": "I slept well", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm1_v2", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_anxious_v2", + "form_name": "esm28q", + "section_header": "Think of the moment just before this task", + "field_type": "range", + "field_label": "I feel anxious", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": 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"branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm2_v2", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_down_v2", + "form_name": "esm28q", + "section_header": "", + "field_type": "range", + "field_label": "I feel down", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm2_v2", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_relaxed_v2", + "form_name": "esm28q", + "section_header": "", + "field_type": "range", + "field_label": "I feel relaxed", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm2_v2", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_stressed_v2", + "form_name": 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"code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm2_v2", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_statisfied_v2", + "form_name": "esm28q", + "section_header": "", + "field_type": "range", + "field_label": "I feel satisfied", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": 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"identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm2_v2", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_qol_v2", + "form_name": "esm28q", + "section_header": "", + "field_type": "range", + "field_label": "Overall, I feel well", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": 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"section_header": "", + "field_type": "radio", + "field_label": "Becoming easily annoyed or irritable", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "gad7", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "gad7_7", + "form_name": "gad7", + "section_header": "", + "field_type": "radio", + "field_label": "Feeling afraid as if something awful might happen", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Several days" + }, + { + "code": "2", + "label": "More than half the days" + }, + { + "code": "3", + "label": "Nearly every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "gad7", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ari_self_1", + "form_name": "ari_self", + "section_header": "For each item, please select the box for Not True, Somewhat True or Certainly True. In the last two weeks and compared to others of the same age, how well does each of the following statements describe your behaviour/feelings? Please try to answer all questions.", + "field_type": "radio", + "field_label": "I am easily annoyed by others", + "select_choices_or_calculations": [ + { + "code": "Nottrue", + "label": "Not True" + }, + { + "code": "Somewhattrue", + "label": "Somewhat True" + }, + { + "code": "Certainlytrue", + "label": "Certainly True" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ari_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ari_self_2", + "form_name": "ari_self", + "section_header": "", + "field_type": "radio", + "field_label": "I often lose my temper", + "select_choices_or_calculations": [ + { + "code": "Nottrue", + "label": "Not True" + }, + { + "code": "Somewhattrue", + "label": "Somewhat True" + }, + { + "code": "Certainlytrue", + "label": "Certainly True" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ari_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ari_self_3", + "form_name": "ari_self", + "section_header": "", + "field_type": "radio", + "field_label": "I stay angry for a long time", + "select_choices_or_calculations": [ + { + "code": "Nottrue", + "label": "Not True" + }, + { + "code": "Somewhattrue", + "label": "Somewhat True" + }, + { + "code": "Certainlytrue", + "label": "Certainly True" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ari_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ari_self_4", + "form_name": "ari_self", + "section_header": "", + "field_type": "radio", + "field_label": "I am angry most of the time", + "select_choices_or_calculations": [ + { + "code": "Nottrue", + "label": "Not True" + }, + { + "code": "Somewhattrue", + "label": "Somewhat True" + }, + { + "code": "Certainlytrue", + "label": "Certainly True" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ari_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ari_self_5", + "form_name": "ari_self", + "section_header": "", + "field_type": "radio", + "field_label": "I get angry frequently", + "select_choices_or_calculations": [ + { + "code": "Nottrue", + "label": "Not True" + }, + { + "code": "Somewhattrue", + "label": "Somewhat True" + }, + { + "code": "Certainlytrue", + "label": "Certainly True" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ari_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ari_self_6", + "form_name": "ari_self", + "section_header": "", + "field_type": "radio", + "field_label": "I lose my temper easily", + "select_choices_or_calculations": [ + { + "code": "Nottrue", + "label": "Not True" + }, + { + "code": "Somewhattrue", + "label": "Somewhat True" + }, + { + "code": 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"required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ari_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_1", + "form_name": "baars_iv", + "section_header": "Please select the item that best describes your behaviour DURING THE PAST 2 WEEKS", + "field_type": "radio", + "field_label": "Fail to give close attention to details or make careless mistakes in my work", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_2", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Fidget with hands or feet or squirm in seat", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_3", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Have difficulty sustaining my attention in tasks or fun activities", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_4", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Leave my seat in situations in which sitting is expected", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_5", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Don't listen when spoken to directly", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_6", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Feel restless", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_7", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Don't follow through on instructions and fail to finish work", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_8", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Have difficulty engaging in leisure activities or doing fun things quietly", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_9", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Have difficulty organising tasks and activities", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_10", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Feel \"on the go\" or \"driven by a motor\"", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_11", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Avoid, dislike, or am reluctant to engage in work that requires sustained mental effort", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_12", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Talk excessively", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_13", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Lose things necessary for tasks or activities", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_14", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Blurt out answers before questions have been completed", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_15", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Easily distracted", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_16", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Have difficulty awaiting turn", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_17", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Forgetful in daily activities", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_sym_18", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "Interrupt or intrude on others", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baars_iv_self", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "age_of_onset", + "form_name": "baars_iv", + "section_header": "", + "field_type": "text", + "field_label": "If you indicated that you experienced any of the problems with attention, concentration, impulsiveness, or hyperactivity above, please indicate here as precisely as you can recall at what age these problems began to occur for you (in years).", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_1", + "form_name": "baars_iv", + "section_header": "To what extent do the problems you may have circled on the previous page interfere with your ability to function in each of these areas of life activities? ", + "field_type": "radio", + "field_label": "In your home life with your immediate family", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_2", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In your work or occupation", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, 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"text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_4", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In your activities or dealings in the community", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_5", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In any educational activities", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_6", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In your dating or marital relationship", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_7", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In your management of money", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_8", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In your driving of a motor vehicle", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_9", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In your leisure or recreational activities", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "baars_iv_self_imp_10", + "form_name": "baars_iv", + "section_header": "", + "field_type": "radio", + "field_label": "In your management of your daily responsibilities", + "select_choices_or_calculations": [ + { + "code": "NeverorRarely", + "label": "Never or Rarely" + }, + { + "code": "Sometimes", + "label": "Sometimes" + }, + { + "code": "Often", + "label": "Often" + }, + { + "code": "VeryOften", + "label": "Very Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "baar_iv_self_imp", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bipq_1", + "form_name": "bipq", + "section_header": "For the following questions, please mark the number that best corresponds to your views: ", + "field_type": "radio", + "field_label": "How much does your epilepsy affect your life?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 No affect at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8" + }, + { + "code": "9", + "label": "9" + }, + { + "code": "10", + "label": "10 Severely affects my life" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bipq_2", + "form_name": "bipq", + "section_header": "", + "field_type": "radio", + "field_label": "How long do you think your epilepsy will continue?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 A very short time" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8" + }, + { + "code": "9", + "label": "9" + }, + { + "code": "10", + "label": "10 Forever" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bipq_3", + "form_name": "bipq", + "section_header": "", + "field_type": "radio", + "field_label": "How much control do you feel you have over your epilepsy?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Absolutely no control" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8" + }, + { + "code": "9", + "label": "9" + }, + { + "code": "10", + "label": "10 Extreme amount of control" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bipq_4", + "form_name": "bipq", + "section_header": "", + "field_type": "radio", + "field_label": "How much do you think your treatment can help your epilepsy?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8" + }, + { + "code": "9", + "label": "9" + }, + { + "code": "10", + "label": "10 Extremely helpful" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bipq_5", + "form_name": "bipq", + "section_header": "", + "field_type": "radio", + "field_label": "How much do you experience symptoms from your epilepsy?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 No symptoms at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8" + }, + { + "code": "9", + "label": 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(e.g. does it make you angry, scared, upset or depressed?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all affected emotionally" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8" + }, + { + "code": "9", + "label": "9" + }, + { + "code": "10", + "label": "10 Extremely affected emotionally" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "medications", + "form_name": "evening_assessment", + "section_header": "Medication Compliance", + "field_type": "radio", + "field_label": "Did you take your medications in the last 24 hours ?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Took all doses" + }, + { + "code": "1", + "label": "Missed at least one dose" + }, + { + "code": "2", + "label": "Missed all doses" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "alcoholuse", + "form_name": "evening_assessment", + "section_header": "Alcohol Use", + "field_type": "radio", + "field_label": "How much alcohol have you consumed in the last 24 hours? ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "None" + }, + { + "code": "2", + "label": "Single small shot of spirits (25ml, ABV 40%) 1 unit" + }, + { + "code": "3", + "label": "Small glass of wine (125ml, ABV 12%) 1.5 units" + }, + { + "code": "4", + "label": "Bottle of lager/beer/cider (330ml, ABV 5%) 1.7 units" + }, + { + "code": "5", + "label": "Can of lager/beer/cider (440ml, ABV 5.5%) 2 units" + }, + { + "code": "6", + "label": "Pint of lower-strength lager/beer/cider (ABV 3.6%) 2 units" + }, + { + "code": "7", + "label": "Standard glass of wine (175ml, ABV 12%) 2.1 units" + }, + { + "code": "8", + "label": "Pint of higher-strength lager/beer/cider (ABV 5.2%) 3 units" + }, + { + "code": "9", + "label": "Large glass of wine (250ml, ABV 12%) 3 units" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "mestrual", + "form_name": "evening_assessment", + "section_header": "Menstrual Cycle", + "field_type": "radio", + "field_label": "Have you got your menstrual period in the last 24 hours? 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obscene phone calls for fun", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never" + }, + { + "code": "1", + "label": "Sometimes" + }, + { + "code": "2", + "label": "Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rpq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rpq_19", + "form_name": "rpq", + "section_header": "", + "field_type": "radio", + "field_label": "Hit others to defend yourself", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never" + }, + { + "code": "1", + "label": "Sometimes" + }, + { + "code": "2", + "label": "Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rpq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rpq_20", + "form_name": "rpq", + "section_header": "", + "field_type": "radio", + "field_label": "Got others to gang up on someone else", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never" + }, + { + "code": "1", + "label": "Sometimes" + }, + { + "code": "2", + "label": "Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rpq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rpq_21", + "form_name": "rpq", + "section_header": "", + "field_type": "radio", + "field_label": "Carried a weapon to use in a fight", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never" + }, + { + "code": "1", + "label": "Sometimes" + }, + { + "code": "2", + "label": "Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rpq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rpq_22", + "form_name": "rpq", + "section_header": "", + "field_type": "radio", + "field_label": "Got angry or mad or hit others when teased", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never" + }, + { + "code": "1", + "label": "Sometimes" + }, + { + "code": "2", + "label": "Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rpq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "rpq_23", + "form_name": "rpq", + "section_header": "", + "field_type": "radio", + "field_label": "Yelled at others so they would do things for you", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Never" + }, + { + "code": "1", + "label": "Sometimes" + }, + { + "code": "2", + "label": "Often" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "rpq", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_1", + "form_name": "qids", + "section_header": "Please mark the one response to each item that best describes you for the past seven days.", + "field_type": "radio", + "field_label": "Falling Asleep:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I never take longer than 30 minutes to fall asleep." + }, + { + "code": "1", + "label": "I take at least 30 minutes to fall asleep, less than half the time (3 days or less out of the last 7 days)." + }, + { + "code": "2", + "label": "I take at least 30 minutes to fall asleep, more than half the time (4 days or more out of the last 7 days)." + }, + { + "code": "3", + "label": "I take more than 60 minutes to fall asleep, more than half the time (4 days or more out of the last 7 days)." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_2", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Sleep During the Night:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I do not wake up at night." + }, + { + "code": "1", + "label": "I have restless nights, sleeping lightly and wake up for a few brief periods each night." + }, + { + "code": "2", + "label": "I wake up at least one or more times a night, but I go back to sleep easily." + }, + { + "code": "3", + "label": "I wake up more than once a night and stay awake for 20 minutes or more, more than half the time (4 days or more out of the last 7 days)." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_3", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Waking Up Too Early:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Most of the time, I wake up no more than 30 minutes before I need to get up." + }, + { + "code": "1", + "label": "More than half the time, I wake up more than 30 minutes before I need to get up (4 days or more out of the last 7 days)." + }, + { + "code": "2", + "label": "I almost always wake up at least one hour or so before I need to, but I go back to sleep eventually." + }, + { + "code": "3", + "label": "I wake up at least one hour before I need to, and cannot go back to sleep 4 days or more out of the last 7 days." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_4", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Sleeping Too Much:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I sleep no longer than 7-8 hours a night, without napping during the day." + }, + { + "code": "1", + "label": "I sleep no longer than 10 hours in a 24-hour period including naps." + }, + { + "code": "2", + "label": "I sleep no longer than 12 hours in a 24-hour period including naps." + }, + { + "code": "3", + "label": "I sleep longer than 12 hours in a 24-hour period including naps." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_5", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Feeling Sad:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I do not feel sad" + }, + { + "code": "1", + "label": "I feel sad less than half the time (3 days or less out of the last 7 days)." + }, + { + "code": "2", + "label": "I feel sad more than half the time (4 days or more out of the last 7 days)." + }, + { + "code": "3", + "label": "I almost always feel sad." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_6", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Decreased Appetite:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "There is no decrease in my usual appetite." + }, + { + "code": "1", + "label": "I eat rather less often or lesser amounts of food than usual." + }, + { + "code": "2", + "label": "I eat much less than usual and only with personal effort." + }, + { + "code": "3", + "label": "I rarely eat within a 24-hour period, and only with extreme personal effort or when others persuade me to eat." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_7", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Increased Appetite:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "There is no increase from my usual appetite." + }, + { + "code": "1", + "label": "I feel a need to eat more frequently than usual." + }, + { + "code": "2", + "label": "I regularly eat more often and/or greater amounts of food than usual." + }, + { + "code": "3", + "label": "I feel driven to overeat both at mealtime and between meals." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[qids_6] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['qids_6'] == '0'" + }, + { + "field_name": "qids_8", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Decreased Weight (Within the Last Two Weeks):", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I have not had a decrease in my weight." + }, + { + "code": "1", + "label": "I feel as if I have had a slight weight loss." + }, + { + "code": "2", + "label": "I have lost 2 pounds/1 Kg or more." + }, + { + "code": "3", + "label": "I have lost 5 pounds/2 Kg or more." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_9", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Increased Weight (Within the Last Two Weeks):", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I have not had an increase in my weight." + }, + { + "code": "1", + "label": "I feel as if I've had a slight weight gain." + }, + { + "code": "2", + "label": "I have gained 2 pounds/1 Kg or more." + }, + { + "code": "3", + "label": "I have gained 5 pounds/2 Kg or more." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[qids_8] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['qids_8'] == '0'" + }, + { + "field_name": "qids_10", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Concentration/Decision Making:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "There is no change in my usual capacity to concentrate or make decisions." + }, + { + "code": "1", + "label": "I occasionally feel indecisive or find that my attention wanders." + }, + { + "code": "2", + "label": "Most of the time, I struggle to focus my attention or to make decisions." + }, + { + "code": "3", + "label": "I cannot concentrate well enough to read or cannot make even minor decisions." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_11", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "View of Myself:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I see myself as equally worthwhile and deserving as other people." + }, + { + "code": "1", + "label": "I am more self-blaming than usual." + }, + { + "code": "2", + "label": "I largely believe that I cause problems for others." + }, + { + "code": "3", + "label": "I think almost constantly about major and minor defects in myself." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_12", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Thoughts of Death or Suicide:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I do not think of suicide or death." + }, + { + "code": "1", + "label": "I feel that life is empty or wonder if it is worth living." + }, + { + "code": "2", + "label": "I have thought of suicide or death several times over the last seven days for several minutes." + }, + { + "code": "3", + "label": "I think of suicide or death several times a day in some detail, or I have made specific plans for suicide or have actually tried to take my life." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_13", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "General Interest:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "There is no change from usual in how interested I am in other people or activities." + }, + { + "code": "1", + "label": "I notice that I am less interested in people or activities." + }, + { + "code": "2", + "label": "I find I have interest in only one or two of my formerly pursued activities." + }, + { + "code": "3", + "label": "I have very little interest in formerly pursued activities." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_14", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Energy Level:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "There is no change in my usual level of energy." + }, + { + "code": "1", + "label": "I get tired more easily than usual." + }, + { + "code": "2", + "label": "I have to make a big effort to start or finish my usual daily activities (for example, shopping, homework, cooking or going to work)." + }, + { + "code": "3", + "label": "I really cannot carry out most of my usual daily activities because I just do not have the energy." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_15", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Feeling slowed down:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I think, speak, and move at my usual rate of speed." + }, + { + "code": "1", + "label": "I find that my thinking is slower or my voice sounds dull or flat." + }, + { + "code": "2", + "label": "It takes me several seconds to respond to most questions and I am sure my thinking is slower." + }, + { + "code": "3", + "label": "I am often unable to respond to questions without extreme effort." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "qids_16", + "form_name": "qids", + "section_header": "", + "field_type": "radio", + "field_label": "Feeling restless:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I do not feel restless." + }, + { + "code": "1", + "label": "I am often fidgety, wringing my hands, or need to shift how I am sitting." + }, + { + "code": "2", + "label": "I have impulses to move about and am quite restless." + }, + { + "code": "3", + "label": "At times, I am unable to stay seated and need to pace around." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "wsas_0", + "form_name": "wsas", + "section_header": "", + "field_type": "radio", + "field_label": "Are you retired or do you choose not to have a job for reasons unrelated to your depression?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "work", + "form_name": "wsas", + "section_header": "", + "field_type": "radio", + "field_label": "Because of my depression my ability to work is impaired. '0' means 'not at all impaired'and '8' means very severely impaired to the point I can't work", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2 Slightly" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4 Definitely" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6 Markedly" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8 Very Severely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "wsas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "home_management", + "form_name": "wsas", + "section_header": "", + "field_type": "radio", + "field_label": "Because of my depression my home management (cleaning, tidying, shopping, cooking, looking after home or children, paying bills) is impaired.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2 Slightly" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4 Definitely" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6 Markedly" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8 Very Severely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "wsas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "social_activities", + "form_name": "wsas", + "section_header": "", + "field_type": "radio", + "field_label": "Because of my depression my social leisure activities (with other people e.g. parties, bars, clubs, outings, visits, dating, home entertaining) are impaired.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2 Slightly" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4 Definitely" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6 Markedly" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8 Very Severely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "wsas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "private_leisure", + "form_name": "wsas", + "section_header": "", + "field_type": "radio", + "field_label": "Because of my depression, my private leisure activities (done alone, such as reading, gardening, collecting, sewing, walking alone) are impaired.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2 Slightly" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4 Definitely" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6 Markedly" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8 Very Severely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "wsas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "relationhips", + "form_name": "wsas", + "section_header": "", + "field_type": "radio", + "field_label": "Because of my depression, my ability to form and maintain close relationships with others, including those I live with,is impaired.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2 Slightly" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4 Definitely" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6 Markedly" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8 Very Severely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "wsas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ts_1", + "form_name": "treatment_status", + "section_header": "", + "field_type": "yesno", + "field_label": "Are you currently in psychological treatment for depression?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ts_2", + "form_name": "treatment_status", + "section_header": "", + "field_type": "yesno", + "field_label": "Have you missed any sessions this week?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[ts_1] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['ts_1'] == '1'" + }, + { + "field_name": "ts_3", + "form_name": "treatment_status", + "section_header": "", + "field_type": "yesno", + "field_label": "Are you being prescribed medication for your mental health?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ts_4", + "form_name": "treatment_status", + "section_header": "", + "field_type": "yesno", + "field_label": "Have you missed any doses in the past week?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[ts_3] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['ts_3'] == '1'" + }, + { + "field_name": "ts_5", + "form_name": "treatment_status", + "section_header": "", + "field_type": "text", + "field_label": "How many days?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[ts_4] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['ts_4'] == '1'" + }, + { + "field_name": "sse_1", + "form_name": "sleep_questions", + "section_header": "Please rate the following statements as they relate to how you slept last night.", + "field_type": "radio", + "field_label": "I had an adequate amount of sleep last night.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Completely disagree" + }, + { + "code": "2", + "label": "Somewhat disagree" + }, + { + "code": "3", + "label": "Neither agree nor disagree" + }, + { + "code": "4", + "label": "Somewhat agree" + }, + { + "code": "5", + "label": "Completely agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sse", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sse_2", + "form_name": "sleep_questions", + "section_header": "", + "field_type": "radio", + "field_label": "I feel refreshed after last night's sleep.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Completely disagree" + }, + { + "code": "2", + "label": "Somewhat disagree" + }, + { + "code": "3", + "label": "Neither agree nor disagree" + }, + { + "code": "4", + "label": "Somewhat agree" + }, + { + "code": "5", + "label": "Completely agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sse", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sse_3", + "form_name": "sleep_questions", + "section_header": "", + "field_type": "radio", + "field_label": "Overall, I slept well last night.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Completely disagree" + }, + { + "code": "2", + "label": "Somewhat disagree" + }, + { + "code": "3", + "label": "Neither agree nor disagree" + }, + { + "code": "4", + "label": "Somewhat agree" + }, + { + "code": "5", + "label": "Completely agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sse", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sas_1", + "form_name": "social_activities", + "section_header": "Below you will find a series of activities, please indicate the number of times you have done each of these things during the past 2 weeks by selecting the box that represents your answer.", + "field_type": "radio", + "field_label": "Visited with friends at your / their home.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5+" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sas_2", + "form_name": "social_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Visited with relatives at your / their home.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5+" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sas_3", + "form_name": "social_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Participated in sports or other physical exercise or activity with other(s).", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5+" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sas_4", + "form_name": "social_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Went to a restaurant / pub / bar / coffee shop for a meal, drink, dessert, etc. with other(s).", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5+" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sas_5", + "form_name": "social_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Went on outings (e.g. picnics, parties, movies, plays, sporting events, museums, concerts) etc. with other(s).", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5+" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sas_6", + "form_name": "social_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Performed family or personal errands away from home, such as grocery shopping, going to the doctor, taking the kids somewhere, etc. with other(s).", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5+" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sas_7", + "form_name": "social_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Listened to music or watched television, films, etc. with other(s).", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5+" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sas", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "diagnosis_test", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "yesno", + "field_label": "Have you been diagnosed with COVID-19 (Coronavirus-2)?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "diagnosis_date", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "text", + "field_label": "When were you diagnosed?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "date_dmy", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[diagnosis_test] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['diagnosis_test'] == '1'" + }, + { + "field_name": "cv19_test_type", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "checkbox", + "field_label": "What type of diagnostic test did you receive?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Antibody Test (for a previous infection)" + }, + { + "code": "2", + "label": "Antigen Test (for current infection)" + }, + { + "code": "3", + "label": "Throat or Nasal Swab (for viral RNA)" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[diagnosis_test] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['diagnosis_test'] == '1'" + }, + { + "field_name": "self_isolation", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "yesno", + "field_label": "Are you in self-isolation?\n(please answer again if self-isolation is being repeated)", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "self_isolate_date", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "text", + "field_label": "When did you self-isolate?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "date_dmy", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[self_isolation] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['self_isolation'] == '1'" + }, + { + "field_name": "diagnosis_family", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "yesno", + "field_label": "Has anyone you live with had these symptoms or been diagnosed with COVID-19 (Coronavirus)?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "family_diag_date", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "text", + "field_label": "When was your household member diagnosed?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "date_dmy", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[diagnosis_family] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['diagnosis_family'] == '1'" + }, + { + "field_name": "daily_activities", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "yesno", + "field_label": "Have you changed your day to day activities since the COVID-19 outbreak? \n\nFor example, working from home; having to look after children because of school closures; having to look after an ill relative", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "medications_intake", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "yesno", + "field_label": "Are you taking any medication?\n\nEither for prior conditions or to treat symptoms of COVID19?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "covid_meds_dlist", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "checkbox", + "field_label": "Please select if you are taking one or more of these?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Ibuprofen" + }, + { + "code": "3", + "label": "Vitamin D" + }, + { + "code": "4", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[medications_intake] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['medications_intake'] == '1'" + }, + { + "field_name": "covid19_meds_other", + "form_name": "covid19_diagnosis", + "section_header": "", + "field_type": "text", + "field_label": "Please enter the names of any other medications below:\n\n(separate with comma)", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[covid_meds_dlist(4)] = '1' and [medications_intake] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['covid_meds_dlist'] == 4 && responses['medications_intake'] == '1'" + }, + { + "field_name": "changed", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "yesno", + "field_label": "Have there been any changes since last completing this questionnaire:\n\n**First time completing? please select YES**", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sym_fever", + "form_name": "covid19_symptoms", + "section_header": "Have you experienced any of the following:", + "field_type": "radio", + "field_label": "Fever (including feeling cold and shivering)?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_a_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_cough", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Coughing?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_a_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "mucus_q", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "checkbox", + "field_label": "Describe phlegm being produced:", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Mucus is clear" + }, + { + "code": "2", + "label": "Mucus is white" + }, + { + "code": "3", + "label": "Mucus is yellow" + }, + { + "code": "4", + "label": "Mucus has signs of blood" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[sym_cough] = '1' or [sym_cough] = '2' or [sym_cough] = '3'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['sym_cough'] == '1' || responses['sym_cough'] == '2' || responses['sym_cough'] == '3'" + }, + { + "field_name": "sym_breath", + "form_name": "covid19_symptoms", + "section_header": "Have you experienced any of the following:", + "field_type": "radio", + "field_label": "Breathing difficulties?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_fatigue", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Fatigue?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_anosmia", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Loss of Sense of Smell (Anosmia)?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_nasal_cong", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Nasal Congestion?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_muscle_pain", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Muscle Pain / Joint Pain?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_sore_throat", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Sore Throat?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_headache", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Headache?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_chills", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Chills?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "sym_nausea", + "form_name": "covid19_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "Nausea / Vomiting?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None" + }, + { + "code": "1", + "label": "1 Mild" + }, + { + "code": "2", + "label": "2 Moderate" + }, + { + "code": "3", + "label": "3 Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[changed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "symptoms_b_cov19", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['changed'] == '1'" + }, + { + "field_name": "intro_cns", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "info", + "field_label": "Introduction", + "select_choices_or_calculations": [ + { + "code": "Part1", + "label": "Thank you once again for your ongoing support of the RADAR trial. We really appreciate your continued participation, especially given the recent outbreak of COVID-19 (Coronavirus). Your valued contributions are now more important than ever to help us gain a better understanding and insight, into the lives of people living with major depressive disorder." + }, + { + "code": "Part2", + "label": "We therefore ask you to continue to engage with RADAR as best you can during this period. We would also really appreciate if you took the time to answer the following additional questions, which specifically relate to your experiences of COVID-19 (Coronavirus)." + }, + { + "code": "Part3", + "label": "If you have any concerns or need any advice regarding COVID-19 (Coronavirus) we recommend visiting the following link for further information https://111.nhs.uk/service/COVID-19/" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "info-type", + "evaluated_logic": "" + }, + { + "field_name": "symptoms_cns", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "checkbox", + "field_label": "Have you had any of the following symptoms since the outbreak of COVID-19 (Coronavirus)? Tick if applicable.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "A cough" + }, + { + "code": "2", + "label": "A fever (i.e. a temperature > 38oCelsius and/or feeling cold and shivering)" + }, + { + "code": "3", + "label": "Shortness of breath and/or difficulty breathing" + }, + { + "code": "0", + "label": "None of the above" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "diag_cns", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "radio", + "field_label": "Have you been diagnosed with COVID-19 (Coronavirus)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "hospitalised_cns", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "radio", + "field_label": "Have you been hospitalised?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[diag_cns] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['diag_cns'] == '1'" + }, + { + "field_name": "alone_cns", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "radio", + "field_label": "Do you live alone at the moment?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "symptoms_cns_fam", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "checkbox", + "field_label": "Has anyone you live with had any of the following symptoms since the outbreak of COVID-19 (Coronavirus)? Tick if applicable.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "A cough" + }, + { + "code": "2", + "label": "A fever (i.e. a temperature > 38oCelsius and/or feeling cold and shivering)" + }, + { + "code": "3", + "label": "Shortness of breath and/or difficulty breathing" + }, + { + "code": "0", + "label": "None of the above" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[alone_cns] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['alone_cns'] == '0'" + }, + { + "field_name": "diag_fam_cns", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "radio", + "field_label": "Has anyone you live with been diagnosed with COVID-19 (Coronavirus)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[alone_cns] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['alone_cns'] == '0'" + }, + { + "field_name": "hospitalised_fam_cns_2", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "radio", + "field_label": "Have they been hospitalised?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[diag_fam_cns] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['diag_fam_cns'] == '1'" + }, + { + "field_name": "friend_diag_cns", + "form_name": "cns_covid19_baseline", + "section_header": "", + "field_type": "radio", + "field_label": "Has a family member or friend been diagnosed with COVID-19 (Coronavirus)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "hospitalised_friend_cns", + "form_name": 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"field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[protect_vit_d] = '1' or [other_vit_d] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['protect_vit_d'] == '1' || responses['other_vit_d'] == '1'" + }, + { + "field_name": "vitd_kaletra_note", + "form_name": "vitd_and_kaletra_notification", + "section_header": "", + "field_type": "info", + "field_label": "", + "select_choices_or_calculations": [ + { + "code": "Notification", + "label": "This is a notification to remind you to take your Vitamin D supplement and Kaletra as part of the PROTECT-NHS study." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + 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We really appreciate your continued participation, especially given the recent outbreak of COVID-19 (Coronavirus). Your valued contributions are now more important than ever to help us gain a better understanding and insight, into the lives of people living with major depressive disorder." + }, + { + "code": "Part2", + "label": "We therefore ask you to continue to engage with RADAR as best you can during this period. We would also really appreciate if you took the time to answer the following additional questions, which specifically relate to your experiences of COVID-19 (Coronavirus)." + }, + { + "code": "Part3", + "label": "If you have any concerns or need any advice regarding COVID-19 (Coronavirus) we recommend visiting the following link for further information https://111.nhs.uk/service/COVID-19/" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "info-type", + "evaluated_logic": "" + }, + { + "field_name": "symptoms_cns_followup_v2", + "form_name": "cns_covid19_followup_v2", + "section_header": "", + "field_type": "checkbox", + "field_label": "Have you had any of the following symptoms in the past 2 weeks? 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We really appreciate your continued participation, especially given the recent outbreak of COVID-19 (Coronavirus). Your valued contributions are now more important than ever to help us gain a better understanding and insight, into the lives of people living with major depressive disorder." + }, + { + "code": "Part2", + "label": "We therefore ask you to continue to engage with RADAR as best you can during this period. 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"text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[diag_fam_cns_followup_v3] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['diag_fam_cns_followup_v3'] == '1'" + }, + { + "field_name": "friend_diag_cns_followup_v3", + "form_name": "cns_covid19_followup_v3", + "section_header": "", + "field_type": "radio", + "field_label": "Has a family member or friend been diagnosed with COVID-19 (Coronavirus), in the past 2 weeks?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + 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"code": "0", + "label": "No" + }, + { + "code": "2", + "label": "Not Applicable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "changes_due_to_outbreak3_followup_v3", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "care_ill_date_followup_v3", + "form_name": "cns_covid19_followup_v3", + "section_header": "", + "field_type": "text", + "field_label": "Since when?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "date_dmy", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[care_ill_followup_v3] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['care_ill_followup_v3'] == '1'" + }, + { + "field_name": "other_change_followup_v3", + "form_name": "cns_covid19_followup_v3", + "section_header": "Have you made any of the following changes due to the COVID-19 (Coronavirus) outbreak?", + "field_type": "radio", + "field_label": "Made changes to any other day to day activities (e.g. hobbies, social events etc.)", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + }, + { + "code": "2", + "label": "Not Applicable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "changes_due_to_outbreak4_followup_v3", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "activities_changed_followup_v3", + "form_name": "cns_covid19_followup_v3", + "section_header": "", + "field_type": "text", + "field_label": "What other activities have you changed and how?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[other_change_followup_v3] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['other_change_followup_v3'] == '1'" + }, + { + "field_name": "activities_c_when_followup_v3", + "form_name": "cns_covid19_followup_v3", + "section_header": "", + "field_type": "text", + "field_label": "Since when did you change these activities?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "date_dmy", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[other_change_followup_v3] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['other_change_followup_v3'] == '1'" + }, + { + "field_name": "n_contacts_followup_v3", + "form_name": "cns_covid19_followup_v3", + "section_header": "", + "field_type": "text", + "field_label": "How many people, from outside your household, have you had a face-to-face conversation with over the last 24 hours?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + 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You can include anything you feel is relevant to your mood and mental health. If you have nothing specific to share, please just enter NONE. Please note, we will not be regularly monitoring the content of these responses and therefore cannot provide support through the answers you provide. If you require additional support, please contact the research team on radar-mdd@kcl.ac.uk.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_med_4weeks", + "form_name": "adhd_medication_use", + "section_header": "", + "field_type": "yesno", + "field_label": "Have you taken any medication for ADHD in the past four weeks? 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Select all that are applicable. ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "A new, continuous cough" + }, + { + "code": "2", + "label": "High temperature" + }, + { + "code": "3", + "label": "Loss or change to your sense of smell or taste" + }, + { + "code": "4", + "label": "None of the above" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_diagnosed", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "yesno", + "field_label": "Have you been diagnosed with Covid-19 (Coronavirus) in the past two weeks? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_hospitalised", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "yesno", + "field_label": "Have you been hospitalised due to Covid-19 (Coronavirus) in the past two weeks? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[follow_diagnosed] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['follow_diagnosed'] == '1'" + }, + { + "field_name": "follow_livewith_alone", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "yesno", + "field_label": "Do you live alone at the moment? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_livewith_number", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "text", + "field_label": "If no, please answer the following questions: \n\nHow many people do you currently live with? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[follow_livewith_alone] = '0'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['follow_livewith_alone'] == '0'" + }, + { + "field_name": "follow_livewith_essential", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "yesno", + "field_label": "Are any adults living in the home an ESSENTIAL WORKER (e.g., healthcare, delivery worker, store worker, security, building maintenance)? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[follow_livewith_alone] = '0'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['follow_livewith_alone'] == '0'" + }, + { + "field_name": "follow_livewith_symptoms", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "checkbox", + "field_label": "Has anyone you live with had any of the following symptoms in the past two weeks? Select all that are applicable. ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "A new, continuous cough" + }, + { + "code": "2", + "label": "High temperature" + }, + { + "code": "3", + "label": "Loss or change to your sense of smell or taste" + }, + { + "code": "4", + "label": "None of the above" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[follow_livewith_alone] = '0'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['follow_livewith_alone'] == '0'" + }, + { + "field_name": "follow_livewith_diagnosed", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "yesno", + "field_label": "Has anyone you live with been diagnosed with Covid-19 (Coronavirus) in the past two weeks? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[follow_livewith_alone] = '0'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['follow_livewith_alone'] == '0'" + }, + { + "field_name": "follow_livewith_hospi", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "yesno", + "field_label": "If yes, have they been hospitalised due to Covid-19 (Coronavirus) in the past two weeks? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[follow_livewith_diagnosed] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['follow_livewith_diagnosed'] == '1'" + }, + { + "field_name": "follow_famfriend_diagnosed", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "yesno", + "field_label": "Has a family member (who you do not live with) or friend been diagnosed with Covid-19 (Coronavirus), in the past two weeks? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_isolation_shielding", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "checkbox", + "field_label": "Have you had to do any of the following due to Covid-19 (Coronavirus) in the past two weeks? Please select all that apply. ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Self-isolation (stayed at home because you had or might have had Coronavirus)" + }, + { + "code": "2", + "label": "Shielding (followed advice to stay home to avoid getting the virus because you are high risk for Coronavirus)" + }, + { + "code": "3", + "label": "None of these" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_workstatus_covid", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "radio", + "field_label": "In the last two weeks, have you worked or studied at home due to Covid-19 (Coronavirus)? ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Full-time" + }, + { + "code": "2", + "label": "Part-time at home and part-time at my usual work/study place" + }, + { + "code": "3", + "label": "Not at all (full time at my usual work/study place)" + }, + { + "code": "4", + "label": "Not currently working due to Coronavirus" + }, + { + "code": "5", + "label": "Not applicable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_childcare_covid", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "radio", + "field_label": "In the last two weeks, have you had to care for children at home because of school closures? ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Full-time" + }, + { + "code": "2", + "label": "Part-time" + }, + { + "code": "3", + "label": "Not at all (children have continued to attend school/nursery)" + }, + { + "code": "4", + "label": "Not applicable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_illcare_affected", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "radio", + "field_label": "In the last two weeks, have you had to care for an ill relative/friend? ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Full-time" + }, + { + "code": "2", + "label": "Part-time" + }, + { + "code": "3", + "label": "Not at all (ill relative/friend has received external care support)" + }, + { + "code": "4", + "label": "Not applicable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_physical_affected", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "radio", + "field_label": "In the last two weeks, how would you describe your level of physical activity (e.g., not able to go to the gym, not going for walks with friends) has been affected by Covid-19 (Coronavirus)? ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all affected" + }, + { + "code": "2", + "label": "Somewhat affected" + }, + { + "code": "3", + "label": "Very affected" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_social_affected", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "radio", + "field_label": "In the last two weeks, how have your social interactions (e.g. meeting up with friends and family) been restricted due to Covid-19 (Coronavirus)? ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all restricted" + }, + { + "code": "2", + "label": "Somewhat restricted" + }, + { + "code": "3", + "label": "Very restricted" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "follow_preoccupied_affected", + "form_name": "art_covid19_followup", + "section_header": "", + "field_type": "radio", + "field_label": "In the last two weeks, have you been preoccupied with (i.e. thinking or worrying too much about) Covid-19 (Coronavirus)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all preoccupied" + }, + { + "code": "2", + "label": "Somewhat preoccupied" + }, + { + "code": "3", + "label": "Very preoccupied" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q1", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 I never cough" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 I cough all the time" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q2", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 I have no phlegm (mucus) on my chest at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 My chest is full of phlegm (mucus)" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q3", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 My chest does not feel tight at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 My chest feels very tight" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q4", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 When I walk up a hill or a flight of stairs I am not out of breath" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 When I walk up a hill or a flight of stairs I am completely out of breath" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q5", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 I am not limited to doing any activities at home" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 I am completely limited to doing all activities at home" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q6", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 I am confident leaving my home despite my lung condition" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 I am not confident leaving my home at all because of my lung condition" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q7", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 I sleep soundly" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 I do not sleep soundly because of my lung condition" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "cat_q8", + "form_name": "cat", + "section_header": "", + "field_type": "radio", + "field_label": "For each item below, select the box that best describes your current situation.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 I have lots of energy" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 I have no energy at all" + } + ], + "field_note": "range_type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pcfs_live_alone", + "form_name": "pcfs", + "section_header": "", + "field_type": "yesno", + "field_label": "Can you live alone without any assistance from another person?\n(e.g. independently being able to eat, walk, use the toilet and manage routine daily hygiene)", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pcfs_duties", + "form_name": "pcfs", + "section_header": "", + "field_type": "yesno", + "field_label": "Are there duties/activities at home or at work which you are no longer able to perform yourself?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[pcfs_live_alone]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['pcfs_live_alone'] == 1" + }, + { + "field_name": "pcfs_suffer", + "form_name": "pcfs", + "section_header": "", + "field_type": "yesno", + "field_label": "Do you suffer from symptoms, pain, depression or anxiety?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[pcfs_duties]=0", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['pcfs_duties'] == 0" + }, + { + "field_name": "pcfs_avoid_duties", + "form_name": "pcfs", + "section_header": "", + "field_type": "yesno", + "field_label": "Do you need to avoid or reduce duties/activities or spread these over time?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[pcfs_suffer]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['pcfs_suffer'] == 1" + }, + { + "field_name": "lipf_stairs", + "form_name": "lipf", + "section_header": "", + "field_type": "yesno", + "field_label": "Did you walk up one flight of stairs in the last 24 hours?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + 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"matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['lipf_grooming'] == 0" + }, + { + "field_name": "lipf_walk_level", + "form_name": "lipf", + "section_header": "", + "field_type": "yesno", + "field_label": "Did you walk outside on a level surface (approximately 150 feet/45 meters, or the distance of half a typical city block) in the last 24 hours?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "lipf_walk_level_yes", + "form_name": "lipf", + "section_header": "", + "field_type": "range", + "field_label": "How short of breath did walking outside on a level surface make you?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4 Extremely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[lipf_walk_level]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['lipf_walk_level'] == 1" + }, + { + "field_name": "lipf_walk_level_no", + "form_name": "lipf", + "section_header": "", + "field_type": "radio", + "field_label": "I did not walk outside on a level surface in the last 24 hours because:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I avoided this activity because it was too 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"field_name": "lipf_shower_no", + "form_name": "lipf", + "section_header": "", + "field_type": "radio", + "field_label": "I did not bathe or shower in the last 24 hours because:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I avoided this activity because it was too difficult to perform" + }, + { + "code": "1", + "label": "Not applicable, because I did not want or have the opportunity to do it" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[lipf_shower]=0", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['lipf_shower'] == 0" + }, + { + "field_name": "lipf_load_light", + "form_name": "lipf", + "section_header": "", + "field_type": "yesno", + "field_label": "Did you lift and carry a light load 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"text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[lipf_load_light]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['lipf_load_light'] == 1" + }, + { + "field_name": "lipf_load_light_no", + "form_name": "lipf", + "section_header": "", + "field_type": "radio", + "field_label": "I did not lift and carry a light load a short distance in the last 24 hours because:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I avoided this activity because it was too difficult to perform" + }, + { + "code": "1", + "label": "Not applicable, because I did not want or have the opportunity to do it" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[lipf_load_light]=0", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['lipf_load_light'] == 0" + }, + { + "field_name": "lipf_short_breath_2", + "form_name": "lipf", + "section_header": "", + "field_type": "yesno", + "field_label": "Did you become short of breath in the last 24 hours?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "lipf_short_breath_2_yes", + "form_name": "lipf", + "section_header": "", + "field_type": "range", + "field_label": "How 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Again, reflect on the last 24 hours as you consider where you are on the scale between the two statements.", + "field_type": "range", + "field_label": "Over the last 24 hours, of all that you wanted to get done, how much did you actually get done?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Nothing" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4 Everything" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "lipf_energy_q2", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "lipf_energy_q3", + "form_name": "lipf", + "section_header": "These items primarily focus on your energy level. 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responses['psqi_trouble_sleep_q10'] == 3" + }, + { + "field_name": "psqi_sleep_quality", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "During the past month, how would you rate your sleep quality overall? ", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Very Good" + }, + { + "code": "1", + "label": "Fairly Good" + }, + { + "code": "2", + "label": "Fairly Bad" + }, + { + "code": "3", + "label": "Very Bad" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "psqi_medicine_q1", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "During the past month, how often have you taken medicine to help you sleep (prescribed or \"over the counter\")?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not During the Past Month" + }, + { + "code": "1", + "label": "Less Than Once a Week" + }, + { + "code": "2", + "label": "Once or Twice a Week" + }, + { + "code": "3", + "label": "Three or More Times a Week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "psq_medicine", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "psqi_medicine_q2", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "During the past month, how often have you had trouble staying awake while driving, eating meals, or engaging in social activity?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not During the Past Month" + }, + { + "code": "1", + "label": "Less Than Once a Week" + }, + { + "code": "2", + "label": "Once or Twice a Week" + }, + { + "code": "3", + "label": "Three or More Times a Week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "psq_medicine", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "psqi_enthusiasm", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "During the past month, how much of a problem has it been for you to keep up enough enthusiasm to get things done? ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "No problem at all" + }, + { + "code": "2", + "label": "Only a very slight problem" + }, + { + "code": "3", + "label": "Somewhat of a problem" + }, + { + "code": "4", + "label": "A very big problem" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "psqi_roommate", + "form_name": "psqi", + "section_header": "", + "field_type": "yesno", + "field_label": "Do you have a bed partner or roommate? ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "psqi_roommate_q1", + "form_name": "psqi", + "section_header": "If you have a room mate or bed partner, ask him/her how often in the past month you have had ...", + "field_type": "radio", + "field_label": "... loud snoring", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not During the Past Month" + }, + { + "code": "1", + "label": "Less Than Once a Week" + }, + { + "code": "2", + "label": "Once or Twice a Week" + }, + { + "code": "3", + "label": "Three or More Times a Week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[psqi_roommate]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "psqi_roommate_q", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['psqi_roommate'] == 1" + }, + { + "field_name": "psqi_roommate_q2", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "... long pauses between breaths while asleep", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not During the Past Month" + }, + { + "code": "1", + "label": "Less Than Once a Week" + }, + { + "code": "2", + "label": "Once or Twice a Week" + }, + { + "code": "3", + "label": "Three or More Times a Week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[psqi_roommate]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "psqi_roommate_q", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['psqi_roommate'] == 1" + }, + { + "field_name": "psqi_roommate_q3", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "... legs twitching or jerking while you sleep", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not During the Past Month" + }, + { + "code": "1", + "label": "Less Than Once a Week" + }, + { + "code": "2", + "label": "Once or Twice a Week" + }, + { + "code": "3", + "label": "Three or More Times a Week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[psqi_roommate]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "psqi_roommate_q", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['psqi_roommate'] == 1" + }, + { + "field_name": "psqi_roommate_q4", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "... episodes of disorientation or confusion during sleep", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not During the Past Month" + }, + { + "code": "1", + "label": "Less Than Once a Week" + }, + { + "code": "2", + "label": "Once or Twice a Week" + }, + { + "code": "3", + "label": "Three or More Times a Week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[psqi_roommate]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "psqi_roommate_q", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['psqi_roommate'] == 1" + }, + { + "field_name": "psqi_roommate_q5", + "form_name": "psqi", + "section_header": "", + "field_type": "radio", + "field_label": "Other restlessness while you sleep", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not During the Past Month" + }, + { + "code": "1", + "label": "Less Than Once a Week" + }, + { + "code": "2", + "label": "Once or Twice a Week" + }, + { + "code": "3", + "label": "Three or More Times a Week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[psqi_roommate]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "psqi_roommate_q", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['psqi_roommate'] == 1" + }, + { + "field_name": "psqi_other_restlessness", + "form_name": "psqi", + "section_header": "", + "field_type": "text", + "field_label": "Please Describe the Other restlessness mentioned in the previous question", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[psqi_roommate_q5]=1 or [psqi_roommate_q5]=2 or [psqi_roommate_q5]=3", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['psqi_roommate_q5'] == 1 || responses['psqi_roommate_q5'] == 2 || responses['psqi_roommate_q5'] == 3" + }, + { + "field_name": "fss_fatigue_q1", + "form_name": "fss", + "section_header": "Please Select the number between 1 and 7 which you feel best fits the following statements. This\nrefers to your usual way of life within the last week.", + "field_type": "range", + "field_label": "My motivation is lower when I am fatigued.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q2", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "Exercise brings on my fatigue.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q3", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "I am easily fatigued.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q4", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "Fatigue interferes with my physical functioning.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q5", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "Fatigue causes frequent problems for me.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q6", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "My fatigue prevents sustained physical functioning.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q7", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "Fatigue interferes with carrying out certain duties and responsibilities.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q8", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "Fatigue is among my most disabling symptoms.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "fss_fatigue_q9", + "form_name": "fss", + "section_header": "", + "field_type": "range", + "field_label": "Fatigue interferes with my work, family, or social life.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Strongly Disagree" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Strongly Agree" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "fss_fatigue", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "vafs", + "form_name": "fss", + "section_header": "", + "field_type": "slider", + "field_label": "Please select on the number line which describes your global fatigue with 0 being worst and 10 being normal.", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "10", + "step": 1, + "labelLeft": "Worst", + "labelRight": "Normal" + }, + "evaluated_logic": "" + }, + { + "field_name": "please_get_your_pulse_oxim", + "form_name": "pulse_ox", + "section_header": "", + "field_type": "info", + "field_label": "Please get your finger Pulse Oximeter and start the recording. The next questions will ask you to enter the values displayed on your Pulse Oximeter. Make sure you are at least 10 minutes at rest before starting the recording. Please give the device at least 2 minutes to stabilize before providing the values.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "info-type", + "evaluated_logic": "" + }, + { + "field_name": "please_enter_the_pulse_oxi", + "form_name": "pulse_ox", + "section_header": "", + "field_type": "slider", + "field_label": "Please Enter the Oximetery (SpO2) value displayed on the device.", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "70", + "max": "100", + "step": 1, + "labelLeft": "70%", + "labelRight": "100%" + }, + "evaluated_logic": "" + }, + { + "field_name": "please_enter_the_hr", + "form_name": "pulse_ox", + "section_header": "", + "field_type": "slider", + "field_label": "Please Enter the Heart Rate (bpm) value displayed on the device.", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "50", + "max": "150", + "step": 1, + "labelLeft": "50 bpm", + "labelRight": "150 bpm" + }, + "evaluated_logic": "" + }, + { + "field_name": "fever", + "form_name": "ralpmh_covid_symptoms", + "section_header": "Do you have any COVID-19 Symptoms?", + "field_type": "matrix-radio", + "field_label": "Fever", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "None" + }, + { + "code": "1", + "label": "Mild" + }, + { + "code": "2", + "label": "Moderate" + }, + { + "code": "3", + "label": "Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "covid_symptom_common", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "dry_cough", + "form_name": "ralpmh_covid_symptoms", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Dry cough", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "None" + }, + { + "code": "1", + "label": "Mild" + }, + { + "code": "2", + "label": "Moderate" + }, + { + "code": "3", + "label": "Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "covid_symptom_common", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "tiredness_or_fatigue", + "form_name": "ralpmh_covid_symptoms", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Tiredness or fatigue", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "None" + }, + { + "code": "1", + "label": "Mild" + }, + { + "code": "2", + "label": "Moderate" + }, + { + "code": "3", + "label": "Severe" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + 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"code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "cough_matrix", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "phlegm", + "form_name": "vaping_weekly_survey", + "section_header": "Please mark the response that best describes you currently.", + "field_type": "range", + "field_label": "How much phlegm (mucus) is on your chest?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 None at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 Full of phlegm" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phlegm_matrix", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "chest", + "form_name": "vaping_weekly_survey", + "section_header": "Please mark the response that best describes you currently.", + "field_type": "range", + "field_label": "Does your chest feel tight?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 Very tight" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "chest_matrix", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "breath", + "form_name": "vaping_weekly_survey", + "section_header": "Please mark the response that best describes you currently.", + "field_type": "range", + "field_label": "When I walk up a hill or a flight of stairs", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 I am not out of breath" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 I am completely out of breath" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "breath_matrix", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "sleep", + "form_name": "vaping_weekly_survey", + "section_header": "Please mark the response that best describes you currently.", + "field_type": "range", + "field_label": "How soundly do you sleep?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Soundly" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 Not soundly" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sleep_matrix", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "energy", + "form_name": "vaping_weekly_survey", + "section_header": "Please mark the response that best describes you currently.", + "field_type": "range", + "field_label": "How much energy do you have?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0 Lots of energy" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5 No energy at all" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "energy_matrix", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "smoke_days", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "radio", + "field_label": "In the past 7 days, on how many days did you smoke cigarettes?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "Don't know" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "smoke_days_3", + "form_name": 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"form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "slider", + "field_label": "On days that you smoked, on average, how many cigarettes did you smoke?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smoke_days_3] = '1'", + "required_field": "", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "cigarettes", + "labelRight": "cigarettes" + }, + "evaluated_logic": "responses['smoke_days_3'] == '1'" + }, + { + "field_name": "smoke_days_2", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "radio", + "field_label": "In the past 7 days, on how many days did you vape/ use your e-cigarette? ", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "0" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "Don't know" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "smoke_days_5", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "radio", + "field_label": "What electronic cigarette or vaping device do you currently use the most? \n", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "A disposable e-cigarette or vaping device (non-rechargeable)" + }, + { + "code": "1", + "label": "An e-cigarette or vaping device that uses replaceable pre-filled cartridges or pods (rechargeable)" + }, + { + "code": "2", + "label": "An e-cigarette or vaping device with a tank that you refill with liquids (rechargeable)" + }, + { + "code": "3", + "label": "A modular system that you refill with liquids (rechargeable, and you use your own combination of separate devices: batteries, atomisers, etc.)" + }, + { + "code": "4", + "label": "Don't know" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smoke_days_2] = '1' or [smoke_days_2] = '2' or [smoke_days_2] = '3' or [smoke_days_2] = '4' or [smoke_days_2] = '5' or [smoke_days_2] = '6' or [smoke_days_2] = '7'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smoke_days_2'] == '1' || responses['smoke_days_2'] == '2' || responses['smoke_days_2'] == '3' || responses['smoke_days_2'] == '4' || responses['smoke_days_2'] == '5' || responses['smoke_days_2'] == '6' || responses['smoke_days_2'] == '7'" + }, + { + "field_name": "smoke_days_6", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "radio", + "field_label": "What flavour do you use most when vaping/using an e-cigarette or vaping device? ", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Tobacco" + }, + { + "code": "1", + "label": "Tobacco menthol," + }, + { + "code": "2", + "label": "Menthol or mint" + }, + { + "code": "3", + "label": "Fruit flavour" + }, + { + "code": "4", + "label": "Coffee flavour" + }, + { + "code": "5", + "label": "Vanilla flavour" + }, + { + "code": "6", + "label": "Chocolate, desserts, sweet, candy flavour" + }, + { + "code": "7", + "label": "Energy drink or soft drink flavour" + }, + { + "code": "8", + "label": "An alcoholic drink flavour (e.g. wine, whiskey, gin, mojito or other cocktails)" + }, + { + "code": "9", + "label": "Other flavour" + }, + { + "code": "10", + "label": "No flavour" + }, + { + "code": "11", + "label": "Don't know" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smoke_days_2] = '1' or [smoke_days_2] = '2' or [smoke_days_2] = '3' or [smoke_days_2] = '4' or [smoke_days_2] = '5' or [smoke_days_2] = '6' or [smoke_days_2] = '7'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smoke_days_2'] == '1' || responses['smoke_days_2'] == '2' || responses['smoke_days_2'] == '3' || responses['smoke_days_2'] == '4' || responses['smoke_days_2'] == '5' || responses['smoke_days_2'] == '6' || responses['smoke_days_2'] == '7'" + }, + { + "field_name": "smoke_days_7", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "radio", + "field_label": "Which of these nicotine strengths do you use most often? ", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "No nicotine (0mg/ml; 0%)" + }, + { + "code": "1", + "label": "1 to 8 mg/ml (0.1% to 0.8%)" + }, + { + "code": "2", + "label": "9 to 14 mg/ml (0.9% to 1.4%)" + }, + { + "code": "3", + "label": "15 to 20 mg/ml (1.5% to 2.0%)" + }, + { + "code": "4", + "label": "21 to 24mg/ml (2.1 to 2.4%)" + }, + { + "code": "5", + "label": "25mg/ml (2.5%) or more" + }, + { + "code": "6", + "label": "Don't know" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smoke_days_2] = '1' or [smoke_days_2] = '2' or [smoke_days_2] = '3' or [smoke_days_2] = '4' or [smoke_days_2] = '5' or [smoke_days_2] = '6' or [smoke_days_2] = '7'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smoke_days_2'] == '1' || responses['smoke_days_2'] == '2' || responses['smoke_days_2'] == '3' || responses['smoke_days_2'] == '4' || responses['smoke_days_2'] == '5' || responses['smoke_days_2'] == '6' || responses['smoke_days_2'] == '7'" + }, + { + "field_name": "smoke_days_8", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "radio", + "field_label": "Do the e-cigarettes, cartridges, pods, or e-liquids you currently use contain nicotine salts?  ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + }, + { + "code": "2", + "label": "I don't know if they contain nicotine salt or not" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smoke_days_2] = '1' or [smoke_days_2] = '2' or [smoke_days_2] = '3' or [smoke_days_2] = '4' or [smoke_days_2] = '5' or [smoke_days_2] = '6' or [smoke_days_2] = '7'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smoke_days_2'] == '1' || responses['smoke_days_2'] == '2' || responses['smoke_days_2'] == '3' || responses['smoke_days_2'] == '4' || responses['smoke_days_2'] == '5' || responses['smoke_days_2'] == '6' || responses['smoke_days_2'] == '7'" + }, + { + "field_name": "smoke_days_9", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "radio", + "field_label": "Do you think electronic cigarettes/vaping devices (with nicotine) are more harmful than smoking tobacco cigarettes, less harmful, or are they equally harmful to health? ", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "A lot more harmful than tobacco cigarettes" + }, + { + "code": "1", + "label": "More harmful than tobacco cigarettes" + }, + { + "code": "2", + "label": "Equally harmful" + }, + { + "code": "3", + "label": "Less harmful than tobacco cigarettes" + }, + { + "code": "4", + "label": "A lot less harmful than tobacco cigarettes" + }, + { + "code": "5", + "label": "Don't know" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "unexplained_pain", + "form_name": "vaping_weekly_survey", + "section_header": "In the last few weeks, have you had the following:", + "field_type": "matrix-radio", + "field_label": "Unexplained pain or ache", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "last_two_weeks_matrix", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "night_sweats", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Very heavy night sweats", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "last_two_weeks_matrix", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "weight_loss", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Unexplained weight loss", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "last_two_weeks_matrix", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "unusual_lump", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Unusual lump or swelling anywhere", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "last_two_weeks_matrix", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "unusual_fatigue", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Unusual fatigue", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "last_two_weeks_matrix", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "smoke_days_10", + "form_name": "vaping_weekly_survey", + "section_header": "", + "field_type": "slider", + "field_label": "To help people say how good or bad their health state is, we have drawn a scale (rather like a thermometer) on which the best state you can imagine is marked 100 and the worst state you can imagine is marked 0. Please indicate on this scale how good or bad your own health is today, in your opinion.  ", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "Worst", + "labelRight": "Best" + }, + "evaluated_logic": "" + }, + { + "field_name": "how_likely_do_you_feel_it_ild", + "form_name": "exacerbation_diary_ild", + "section_header": "", + "field_type": "range", + "field_label": "How likely do you think you could be having exacerbation(flare-ups)?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "None" + }, + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "Very Likely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "taking_any_medication_ild", + "form_name": "exacerbation_diary_ild", + "section_header": "", + "field_type": "yesno", + "field_label": "Are you taking any medications for exacerbation today?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "please_select_ild", + "form_name": "exacerbation_diary_ild", + "section_header": "", + "field_type": "checkbox", + "field_label": "Please select the ones that apply:", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Steroids" + }, + { + "code": "1", + "label": "Antibiotics" + }, + { + "code": "2", + "label": "Bronchodilators" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[taking_any_medication_ild]=1", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['taking_any_medication_ild'] == 1" + }, + { + "field_name": "progress_report_1", + "form_name": "progress_report", + "section_header": "", + "field_type": "radio", + "field_label": "Congratulations! You have completed the first week of our Mobile Measures Month. There are three more weeks to go. Please rate how you're getting on below. Don't forget, you can contact us at eu-aims@kcl.ac.uk if you need help.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Everything is going OK" + }, + { + "code": "2", + "label": "I've had some difficulties but I've managed to resolve these myself" + }, + { + "code": "3", + "label": "I had some issues that I need help with" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "progress_report_2", + "form_name": "progress_report", + "section_header": "", + "field_type": "radio", + "field_label": "Congratulations! You have completed the second week of our Mobile Measures Month. You are halfway through! Please let us know how you're getting on. ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Everything is going OK" + }, + { + "code": "2", + "label": "I've had some difficulties but I've managed to resolve these myself" + }, + { + "code": "3", + "label": "I had some issues that I need help with" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "progress_report_3", + "form_name": "progress_report", + "section_header": "", + "field_type": "radio", + "field_label": "Congratulations! You have completed the third week of our Mobile Measures Month. There is just one more week to go! Please let us know how you're getting on. ", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Everything is going OK" + }, + { + "code": "2", + "label": "I've had some difficulties but I've managed to resolve these myself" + }, + { + "code": "3", + "label": "I had some issues that I need help with" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "progress_report_4", + "form_name": "progress_report", + "section_header": "", + "field_type": "descriptive", + "field_label": "Congratulations! You have completed the final week of our Mobile Measures Month. Thank you for participating. We just have some final questions about your experience with our mobile measures system. These will be available for you to answer for the next week.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sleep_quality", + "form_name": "sleep_quality", + "section_header": "Thinking about last night, please consider the quality of your sleep overall, such as how many hours of sleep you got, how easily you fell asleep, how often your woke up during the night, whether you woke up earlier than you had to in the morning, and how refreshing your sleep was. ", + "field_type": "slider", + "field_label": "How would you rate your sleep quality overall (0=worst sleep and 100=best sleep)?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "Terrible", + "labelRight": "Excellent" + }, + "evaluated_logic": "" + }, + { + "field_name": "sleep_quality_info", + "form_name": "sleep_quality_info", + "section_header": "", + "field_type": "info", + "field_label": "Sleep Quality Rating Instructions", + "select_choices_or_calculations": [ + { + "code": "Part1", + "label": "Each morning you will receive a notification to rate how well you slept during the night. We'd like you to consider the quality of your sleep overall, such as how many hours of sleep you got, how easily you fell asleep, how often your woke up during the night, whether you woke up earlier than you had to in the morning, and how refreshing your sleep was." + }, + { + "code": "Part2", + "label": "Please rate your subjective experience without considering any objective ratings that you might notice in the Fitbit app. The rating will be on a scale of 0-100 where 0 means the worst sleep you can imagine and 100 is the best sleep you can imagine." + } + ], + "field_note": "info-type", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "sleep_quality_2", + "form_name": "sleep_quality_info", + "section_header": "Thinking about last night, please consider the quality of your sleep overall, such as how many hours of sleep you got, how easily you fell asleep, how often your woke up during the night, whether you woke up earlier than you had to in the morning, and how refreshing your sleep was. ", + "field_type": "slider", + "field_label": "How would you rate your sleep quality overall (0=worst sleep and 100=best sleep)?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "Terrible", + "labelRight": "Excellent" + }, + "evaluated_logic": "" + }, + { + "field_name": "progress_report1", + "form_name": "progress_report_1", + "section_header": "", + "field_type": "radio", + "field_label": "Congratulations! You have completed the first week of our Mobile Measures Month. There are three more weeks to go. Please rate how you've been getting on over the last week. Don't forget, you can contact us at eu-aims@kcl.ac.uk if you need help.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Everything is going OK" + }, + { + "code": "2", + "label": "I've had some difficulties but I've managed to resolve these myself" + }, + { + "code": "3", + "label": "I had some issues that I need help with" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "progress_report2", + "form_name": "progress_report_2", + "section_header": "", + "field_type": "radio", + "field_label": "Congratulations! You have completed the second week of our Mobile Measures Month. You are halfway through! Please rate how you've been getting on over the last week. Don't forget, you can contact us at eu-aims@kcl.ac.uk if you need help.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Everything is going OK" + }, + { + "code": "2", + "label": "I've had some difficulties but I've managed to resolve these myself" + }, + { + "code": "3", + "label": "I had some issues that I need help with" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "progress_report3", + "form_name": "progress_report_3", + "section_header": "", + "field_type": "radio", + "field_label": "Congratulations! You have completed the third week of our Mobile Measures Month. There is just one more week to go! Please rate how you've been getting on over the last week. Don't forget, you can contact us at eu-aims@kcl.ac.uk if you need help.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Everything is going OK" + }, + { + "code": "2", + "label": "I've had some difficulties but I've managed to resolve these myself" + }, + { + "code": "3", + "label": "I had some issues that I need help with" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "progress_report4", + "form_name": "progress_report_4", + "section_header": "", + "field_type": "descriptive", + "field_label": "Congratulations! You have completed the final week of our Mobile Measures Month. Thank you for participating. We just have some final questions about your experience with our mobile measures system. These will be available for you to answer for the next week.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_desc", + "form_name": "regular_activities", + "section_header": "", + "field_type": "descriptive", + "field_label": "Next, we'd like to get an idea of your regular activities during a typical month, how much time you spend on them, and how much you enjoy them.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_1", + "form_name": "regular_activities", + "section_header": "For each of the following categories, please select how frequently you engage in these activities", + "field_type": "radio", + "field_label": "Eating (e.g. meal times and snacking; count special meals with others as a \"social activity\" not an \"eating\" activity)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "less than 1 hour per day" + }, + { + "code": "1", + "label": "1 to 2 hours per day" + }, + { + "code": "2", + "label": "2 to 3 hours per day" + }, + { + "code": "3", + "label": "over 3 hours per day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_2", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Self-care (e.g. showering/bathing, brushing teeth, doing hair/make-up, doctor/dentist appointments)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "less than 1 hour per day" + }, + { + "code": "1", + "label": "1 to 2 hours per day" + }, + { + "code": "2", + "label": "2 to 3 hours per day" + }, + { + "code": "3", + "label": "over 3 hours per day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_3", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Education/employment/volunteering (e.g. working at your job, school, homework, lectures, babysitting, charity work)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "less than 1 day per week" + }, + { + "code": "1", + "label": "1 to 2 days per week" + }, + { + "code": "2", + "label": "3 to 5 day per week" + }, + { + "code": "3", + "label": "over 5 days per week" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_4", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Household chores/errands (e.g. cooking, cleaning, organising, shopping, childcare)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "less than 1 hour per day" + }, + { + "code": "1", + "label": "1 to 2 hours per day" + }, + { + "code": "2", + "label": "2 to 3 hours per day" + }, + { + "code": "3", + "label": "over 3 hours per day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_9", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Travel (e.g. commuting to work or school, travelling to see family/friends, travelling to an activity)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "less than 1 hour per day" + }, + { + "code": "1", + "label": "1 to 2 hours per day" + }, + { + "code": "2", + "label": "2 to 3 hours per day" + }, + { + "code": "3", + "label": "over 3 hours per day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_5", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Spiritual activities (e.g. attending a religious gathering or ceremony, engaging in prayer/meditation, reading a religious text)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "never or less than once a month" + }, + { + "code": "1", + "label": "1 to 3 times a week" + }, + { + "code": "2", + "label": "most days" + }, + { + "code": "3", + "label": "every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_6", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Exercise/physical activity (e.g. exercise classes, going to the gym, walking/running/jogging, biking, dance, etc.)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "never or less than once a month" + }, + { + "code": "1", + "label": "1 to 3 times a week" + }, + { + "code": "2", + "label": "most days" + }, + { + "code": "3", + "label": "every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_7", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Social activity (e.g. meeting friends/family/partner, socialising online, a meal out with others, dating, doing an activity with friends/family/partner)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "never or less than once a month" + }, + { + "code": "1", + "label": "1 to 3 times a week" + }, + { + "code": "2", + "label": "most days" + }, + { + "code": "3", + "label": "every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_8", + "form_name": "regular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Hobbies/recreation/relaxation that you mostly do alone or without interacting much with others (e.g. sitting/resting, watching television or YouTube, surfing the internet for fun, reading, drawing, scrapbooking, listening to or playing music)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "never or less than once a month" + }, + { + "code": "1", + "label": "1 to 3 times a week" + }, + { + "code": "2", + "label": "most days" + }, + { + "code": "3", + "label": "every day" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_10", + "form_name": "regular_activities", + "section_header": "For each of the following categories, please select how pleasant you usually find these activities", + "field_type": "slider", + "field_label": "Eating (e.g. meal times and snacking; count special meals with others as a \"social activity\" not an \"eating\" activity)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_11", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Self-care (e.g. showering/bathing, brushing teeth, doing hair/make-up, doctor/dentist appointments)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_12", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Education/employment/volunteering (e.g. working at your job, school, homework, lectures, babysitting, charity work)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_13", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Household chores/errands (e.g. cooking, cleaning, organising, shopping, childcare)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_14", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Spiritual activities (e.g. attending a religious gathering or ceremony, engaging in prayer/meditation, reading a religious text)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_15", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Exercise/physical activity (e.g. exercise classes, going to the gym, walking/running/jogging, biking, dance, etc.)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_16", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Social activity (e.g. meeting friends/family/partner, socialising online, a meal out with others, dating, doing an activity with friends/family/partner)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_17", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Hobbies/recreation/relaxation that you mostly do alone or without interacting much with others (e.g. sitting/resting, watching television or YouTube, surfing the internet for fun, reading, drawing, scrapbooking, listening to or playing music)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "regular_activities_18", + "form_name": "regular_activities", + "section_header": "", + "field_type": "slider", + "field_label": "Travel (e.g. commuting to work or school, travelling to see family/friends, travelling to an activity)", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "" + }, + { + "field_name": "nonregular_activities_desc", + "form_name": "nonregular_activities", + "section_header": "", + "field_type": "descriptive", + "field_label": "Finally, we'd like to know about any special events coming up. We'll ask you to describe up to three, and to rate how you feel about them.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "nonregular_activities_1", + "form_name": "nonregular_activities", + "section_header": "", + "field_type": "radio", + "field_label": "Do you have any special or non-regular activities scheduled for the coming month (e.g., a holiday, a special occasion, interview, etc.?)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "No" + }, + { + "code": "1", + "label": "Yes" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "nonregular_activities_2", + "form_name": "nonregular_activities", + "section_header": "Special activity 1", + "field_type": "text", + "field_label": "Please describe the activity you have coming up (e.g., \"weekend away\")", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['nonregular_activities_1'] == '1'" + }, + { + "field_name": "nonregular_activities_3", + "form_name": "nonregular_activities", + "section_header": "Special activity 1", + "field_type": "slider", + "field_label": "Please rate how pleasant you think you will find this activity", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1'", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "responses['nonregular_activities_1'] == '1'" + }, + { + "field_name": "nonregular_activities_4", + "form_name": "nonregular_activities", + "section_header": "Special activity 2", + "field_type": "radio", + "field_label": "Do you have any more special or non-regular activities scheduled for the coming month?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "No" + }, + { + "code": "1", + "label": "Yes" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['nonregular_activities_1'] == '1'" + }, + { + "field_name": "nonregular_activities_5", + "form_name": "nonregular_activities", + "section_header": "Special activity 2", + "field_type": "text", + "field_label": "Please describe the activity you have coming up (e.g., \"weekend away\")", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1' and [nonregular_activities_4] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['nonregular_activities_1'] == '1' && responses['nonregular_activities_4'] == '1'" + }, + { + "field_name": "nonregular_activities_6", + "form_name": "nonregular_activities", + "section_header": "Special activity 2", + "field_type": "slider", + "field_label": "Please rate how pleasant you think you will find this activity", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1' and [nonregular_activities_4] = '1'", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "responses['nonregular_activities_1'] == '1' && responses['nonregular_activities_4'] == '1'" + }, + { + "field_name": "nonregular_activities_7", + "form_name": "nonregular_activities", + "section_header": "Special activity 3", + "field_type": "radio", + "field_label": "Do you have any more special or non-regular activities scheduled for the coming month?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "No" + }, + { + "code": "1", + "label": "Yes" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1' and [nonregular_activities_4] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['nonregular_activities_1'] == '1' && responses['nonregular_activities_4'] == '1'" + }, + { + "field_name": "nonregular_activities_8", + "form_name": "nonregular_activities", + "section_header": "Special activity 3", + "field_type": "text", + "field_label": "Please describe the activity you have coming up (e.g., \"weekend away\")", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1' and [nonregular_activities_4] = '1' and [nonregular_activities_7] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['nonregular_activities_1'] == '1' && responses['nonregular_activities_4'] == '1' && responses['nonregular_activities_7'] == '1'" + }, + { + "field_name": "nonregular_activities_9", + "form_name": "nonregular_activities", + "section_header": "Special activity 3", + "field_type": "slider", + "field_label": "Please rate how pleasant you think you will find this activity", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[nonregular_activities_1] = '1' and [nonregular_activities_4] = '1' and [nonregular_activities_7] = '1'", + "required_field": "", + "custom_alignment": "RV", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "very unpleasant or stressful", + "labelRight": "very pleasant or enjoyable" + }, + "evaluated_logic": "responses['nonregular_activities_1'] == '1' && responses['nonregular_activities_4'] == '1' && responses['nonregular_activities_7'] == '1'" + }, + { + "field_name": "srs_sf_1", + "form_name": "autism_symptoms", + "section_header": "For each question, please select the response that best describes your behaviour over the last week.", + "field_type": "radio", + "field_label": "When under stress, I engage in rigid or inflexible patterns of behaviour that seem odd to people", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_2", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I am usually aware of how others are feeling", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_3", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I behave in ways that seem strange or bizarre to others", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_4", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I am awkward in turn-taking interactions with others (e.g., I have a hard time keeping up with the give-and-take of a conversation)", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_5", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I avoid eye contact or am told that I have unusual eye contact", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_6", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I have difficulty making friends, even when trying my best", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_7", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I interact appropriately with other adults", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_8", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I do not join group activities or social events unless prompted or strongly urged to do so", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_9", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I become upset in situations with lots of things going on", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_10", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I am regarded by others as odd or weird", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_11", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "My behaviour is socially awkward, even when I am trying to be polite", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_12", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I have difficulty relating to adults outside of my family", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_13", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I respond appropriately to mood changes in others (e.g., when a friend's mood changes quickly from happy to sad)", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_14", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "People think I am interested in too few topics, or that I get too carried away with those topics", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_15", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I am overly sensitive to certain sounds, textures, or smells", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "srs_sf_16", + "form_name": "autism_symptoms", + "section_header": "", + "field_type": "radio", + "field_label": "I tend to think about people in the same way that I do about objects", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not true" + }, + { + "code": "2", + "label": "Sometimes true" + }, + { + "code": "3", + "label": "Often true" + }, + { + "code": "4", + "label": "Almost always true" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_1", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently been able to concentrate on what you're doing?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Better than usual" + }, + { + "code": "1", + "label": "Same as usual" + }, + { + "code": "2", + "label": "Less than usual" + }, + { + "code": "3", + "label": "Much less than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_2", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently lost much sleep over worry?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "No more than usual" + }, + { + "code": "2", + "label": "Rather more than usual" + }, + { + "code": "3", + "label": "Much more than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_3", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently felt you were playing a useful part in things?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "More so than usual" + }, + { + "code": "1", + "label": "Same as usual" + }, + { + "code": "2", + "label": "Less useful than usual" + }, + { + "code": "3", + "label": "Much less useful" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_4", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently felt capable of making decisions about things?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "More so than usual" + }, + { + "code": "1", + "label": "Same as usual" + }, + { + "code": "2", + "label": "Less so than usual" + }, + { + "code": "3", + "label": "Much less capable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_5", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently felt constantly under strain?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "No more than usual" + }, + { + "code": "2", + "label": "Rather more than usual" + }, + { + "code": "3", + "label": "Much more than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_6", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently felt you couldn't overcome your difficulties?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "No more than usual" + }, + { + "code": "2", + "label": "Rather more than usual" + }, + { + "code": "3", + "label": "Much more than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_7", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently been able to enjoy your normal day-to-day activities?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "More so than usual" + }, + { + "code": "1", + "label": "Same as usual" + }, + { + "code": "2", + "label": "Less so than usual" + }, + { + "code": "3", + "label": "Much less than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_8", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently been able to face up to your problems?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "More so than usual" + }, + { + "code": "1", + "label": "Same as usual" + }, + { + "code": "2", + "label": "Less so than usual" + }, + { + "code": "3", + "label": "Much less able" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_9", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently been feeling unhappy and depressed?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "No more than usual" + }, + { + "code": "2", + "label": "Rather more than usual" + }, + { + "code": "3", + "label": "Much more than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_10", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently been losing confidence in yourself?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "No more than usual" + }, + { + "code": "2", + "label": "Rather more than usual" + }, + { + "code": "3", + "label": "Much more than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ghq12_11", + "form_name": "ghq12", + "section_header": "", + "field_type": "radio", + "field_label": "Have you recently been thinking of yourself as a worthless person?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "No more than usual" + }, + { + "code": "2", + "label": "Rather more than usual" + }, + { + "code": "3", + "label": "Much more than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": 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"field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "mobility", + "form_name": "eq5d5l", + "section_header": "Please select the ONE option that best describes your health TODAY.", + "field_type": "radio", + "field_label": "Mobility", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I have no problems in walking about" + }, + { + "code": "1", + "label": "I have slight problems in walking about" + }, + { + "code": "2", + "label": "I have moderate problems in walking about" + }, + { + "code": "3", + "label": "I have severe problems in walking about" + }, + { + "code": "4", + "label": "I am unable to walk about" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "mobility", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "self_care", + "form_name": "eq5d5l", + "section_header": "Please select the ONE option that best describes your health TODAY.", + "field_type": "radio", + "field_label": "Self-care", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I have no problems washing or dressing myself" + }, + { + "code": "1", + "label": "I have slight problems washing or dressing myself" + }, + { + "code": "2", + "label": "I have moderate problems washing or dressing myself" + }, + { + "code": "3", + "label": "I have severe problems washing or dressing myself" + }, + { + "code": "4", + "label": "I am unable to wash or dress myself" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "selfcare", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "usual_activities", + "form_name": "eq5d5l", + "section_header": "Please select the ONE option that best describes your health TODAY.", + "field_type": "radio", + "field_label": "Usual Activities", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I have no problems doing my usual activities" + }, + { + "code": "1", + "label": "I have slight problems doing my usual activities" + }, + { + "code": "2", + "label": "I have moderate problems doing my usual activities" + }, + { + "code": "3", + "label": "I have severe problems doing my usual activities" + }, + { + "code": "4", + "label": "I am unable to do my usual activities" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "usualactivities", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "pain_discomfort", + "form_name": "eq5d5l", + "section_header": "Please select the ONE option that best describes your health TODAY.", + "field_type": "radio", + "field_label": "Pain / Discomfort", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I have no pain or discomfort" + }, + { + "code": "1", + "label": "I have slight pain or discomfort" + }, + { + "code": "2", + "label": "I have moderate pain or discomfort" + }, + { + "code": "3", + "label": "I have severe pain or discomfort" + }, + { + "code": "4", + "label": "I have extreme pain or discomfort" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "paindiscomfort", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "anxiety_depression", + "form_name": "eq5d5l", + "section_header": "Please select the ONE option that best describes your health TODAY.", + "field_type": "radio", + "field_label": "Anxiety / Depression", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I am not anxious or depressed" + }, + { + "code": "1", + "label": "I am slightly anxious or depressed" + }, + { + "code": "2", + "label": "I am moderately anxious or depressed" + }, + { + "code": "3", + "label": "I am severely anxious or depressed" + }, + { + "code": "4", + "label": "I am extremely anxious or depressed" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "anxietydepression", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "worthwhile_overall_to_what", + "form_name": "ons2", + "section_header": "", + "field_type": "slider", + "field_label": "Overall, to what extent do you feel that the things you do in your life are worthwhile? where 0 means 'not at all' and 10 means 'completely'", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "10", + "step": 1, + "labelLeft": "Not at all", + "labelRight": "Completely" + }, + "evaluated_logic": "" + }, + { + "field_name": "ons2", + "form_name": "ons2", + "section_header": "", + "field_type": "slider", + "field_label": "Overall, how satisfied are you with your life nowadays? where 0 means 'not at all' and 10 means 'completely'", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "10", + "step": 1, + "labelLeft": "Not at all", + "labelRight": "Completely" + }, + "evaluated_logic": "" + }, + { + "field_name": "chair_rises_instructions", + "form_name": "chair_rises", + "section_header": "", + "field_type": "descriptive", + "field_label": "



Part 1
Comfortable clothing and appropriate footwear should be worn for this test.


Part 2
Sit on a straight back chair (for additional stability, place the rear legs of the chair against a wall so that it cannot slide backwards).


Instruction Video

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If this is the first time you have started an activity, select the checkbox next to 'Walk' and 'Cardio' to add these activities to your favorites." + }, + { + "code": "Part2", + "label": "Using the watch face touchscreen (C), select 'Cardio'" + }, + { + "code": "Part3", + "label": "'Ready' will appear on the watch face'." + }, + { + "code": "Part4", + "label": "Press button A to start the activity timer'" + }, + { + "code": "Part5", + "label": "Go! Stand up and then sit down as quickly as you can 10 times'" + }, + { + "code": "Part6", + "label": "When you have completed 10 chair rises, Stop!" + }, + { + "code": "Part7", + "label": "Check the clock timer on the watch face and sit still for a 1-minute recovery period. After 1 minute of recovery, press button A to stop the activity timer'." + }, + { + "code": "Part8", + "label": "Save the activity by pressing the green tick on the watch face touchscreen (C)." + }, + { + "code": "Part9", + "label": "Congratulations! You have completed your Chair Rises Test." + }, + { + "code": "Part10", + "label": "Please log your most recent test in the next section." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "info-type", + "evaluated_logic": "" + }, + { + "field_name": "chair_rises_completed", + "form_name": "chair_rises", + "section_header": "", + "field_type": "yesno", + "field_label": "Were you able to complete the most recent test?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "chair_rises_datetime", + "form_name": "chair_rises", + "section_header": "", + "field_type": "text", + "field_label": "Please enter the date and time that you started the chair rises test.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "datetime_dmy", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[chair_rises_completed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['chair_rises_completed'] == '1'" + }, + { + "field_name": "chair_rises_borg_scale", + "form_name": "chair_rises", + "section_header": "", + "field_type": "radio", + "field_label": "Please select the option that best describes your level of 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"responses['chair_rises_completed'] == '1'" + }, + { + "field_name": "chair_rises_completed_10", + "form_name": "chair_rises", + "section_header": "", + "field_type": "yesno", + "field_label": "Where you able to complete 10 chair rises?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[chair_rises_completed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['chair_rises_completed'] == '1'" + }, + { + "field_name": "how_many_chair_rises_were", + "form_name": "chair_rises", + "section_header": "", + "field_type": "radio", + "field_label": "How many chair rises were you able to complete?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7" + }, + { + "code": "8", + "label": "8" + }, + { + "code": "9", + "label": "9" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[chair_rises_completed_10] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['chair_rises_completed_10'] == '0'" + }, + { + "field_name": "chair_rises_partial_complete_reason", + "form_name": "chair_rises", + "section_header": "", + "field_type": "radio", + "field_label": "Please select the primary reasons for not fully completing the Chair Rises test", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Fatigue" + }, + { + "code": "1", + "label": "Shortness of breath" + }, + { + "code": "2", + "label": "Too busy" + }, + { + "code": "3", + "label": "Too complicated" + }, + { + "code": "4", + "label": "Injury" + }, + { + "code": "5", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[chair_rises_completed_10] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['chair_rises_completed_10'] == '0'" + }, + { + "field_name": "chair_rises_not_completed_reason", + "form_name": "chair_rises", + "section_header": "", + "field_type": "radio", + "field_label": "Reasons for not completing the Chair Rises test", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "I forgot" + }, + { + "code": "1", + "label": "Fatigue" + }, + { + "code": "2", + "label": "Shortness of breath" + }, + { + "code": "3", + "label": "Too busy" + }, + { + "code": "4", + "label": "Too complicated" + }, + { + "code": "5", + "label": "Injury" + }, + { + "code": "6", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[chair_rises_completed] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['chair_rises_completed'] == '0'" + }, + { + "field_name": "smwt_instructions", + "form_name": "smwt", + "section_header": "", + "field_type": "descriptive", + "field_label": "



Comfortable clothing and appropriate footwear should be worn for this test.



Instruction Video

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If this is the first time you have started an activity, select the checkbox next to 'Walk' and 'Cardio' to add these activities to your favorites" + }, + { + "code": "Part3", + "label": "Using the watch face touchscreen (C), select 'Walk'" + }, + { + "code": "Part4", + "label": "'Wait for GPS' will appear on the watch face'" + }, + { + "code": "Part5", + "label": "Wait for the GPS to connect (this may take 1-2 minutes)" + }, + { + "code": "Part6", + "label": "Ready' will appear on the watch face when the GPS is connected" + }, + { + "code": "Part7", + "label": "Press  button  A to start the activity timer" + }, + { + "code": "Part8", + "label": "Go! Walk as far as you can for 6 minutes" + }, + { + "code": "Part9", + "label": "When the clock timer reads 6:00, Stop!" + }, + { + "code": "Part10", + "label": "Stand still (or sit down if required) for a 1-minute recovery period" + }, + { + "code": "Part11", + "label": "When the clock timer reads 7:00, press button A to stop the activity timer" + }, + { + "code": "Part12", + "label": "Save the activity by pressing the green tick on the watch face touchscreen (C)" + }, + { + "code": "Part13", + "label": "Congratulations! You have completed your 6 Minute Walk Test'" + }, + { + "code": "Part14", + "label": "Please log your most recent test by pressing 'NEXT' below" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "info-type", + "evaluated_logic": "" + }, + { + "field_name": "smwt_completed", + "form_name": "smwt", + "section_header": "", + "field_type": "yesno", + "field_label": "Were you able to complete the most recent test?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + 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[ + { + "code": "0", + "label": "I forgot" + }, + { + "code": "1", + "label": "Fatigue" + }, + { + "code": "2", + "label": "Shortness of breath" + }, + { + "code": "3", + "label": "Too busy" + }, + { + "code": "4", + "label": "Too complicated" + }, + { + "code": "5", + "label": "Injury" + }, + { + "code": "6", + "label": "Poor weather" + }, + { + "code": "7", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smwt_completed] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smwt_completed'] == '0'" + }, + { + "field_name": "smwt_exertion_level", + "form_name": "smwt", + "section_header": "", + "field_type": "radio", + "field_label": "Please select the option that best describes your level of exertion during the test.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Nothing at all" + }, + { + "code": "1", + "label": "Very light" + }, + { + "code": "2", + "label": "Light" + }, + { + "code": "3", + "label": "Moderate" + }, + { + "code": "4", + "label": "Somewhat Hard" + }, + { + "code": "5", + "label": "Hard" + }, + { + "code": "6", + "label": "Hard" + }, + { + "code": "7", + "label": "Very Hard" + }, + { + "code": "8", + "label": "Very Hard" + }, + { + "code": "9", + "label": "Very very hard" + }, + { + "code": "10", + "label": "Very very hard, maximal effort" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smwt_completed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "range-info", + "evaluated_logic": "responses['smwt_completed'] == '1'" + }, + { + "field_name": "smwt_walk_complete_six_min", + "form_name": "smwt", + "section_header": "", + "field_type": "yesno", + "field_label": "Where you able to walk for 6 minutes?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smwt_completed] = '1'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smwt_completed'] == '1'" + }, + { + "field_name": "smwt_walk_min", + "form_name": "smwt", + "section_header": "", + "field_type": "radio", + "field_label": "For approximately how many minutes were you able to walk?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smwt_walk_complete_six_min] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smwt_walk_complete_six_min'] == '0'" + }, + { + "field_name": "smwt_partial_complete_reason", + "form_name": "smwt", + "section_header": "", + "field_type": "radio", + "field_label": "Please select the primary reasons for not fully completing the Six Minute Walking Test", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Fatigue" + }, + { + "code": "1", + "label": "Shortness of breath" + }, + { + "code": "2", + "label": "Too busy" + }, + { + "code": "3", + "label": "Too complicated" + }, + { + "code": "4", + "label": "Injury" + }, + { + "code": "5", + "label": "Poor weather" + }, + { + "code": "6", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[smwt_walk_complete_six_min] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['smwt_walk_complete_six_min'] == '0'" + }, + { + "field_name": "ed15_1", + "form_name": "ed15", + "section_header": "Over the past week, how often have I:", + "field_type": "radio", + "field_label": "Worried about losing control over my eating.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_2", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Avoided activities or people because of the way I look", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_3", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Been preoccupied with thoughts of food and eating", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_4", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Compared my body negatively with others'", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_5", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Avoided looking at my body (e.g., in mirrors; wearing baggy clothes) because of the way it makes me feel", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_6", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Felt distressed about my weight", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_7", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Checked my body to reassure myself about my appearance (e.g., weighing myself; using mirrors)", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_8", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Followed strict rules about my eating", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_9", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Felt distressed about my body shape", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_10", + "form_name": "ed15", + "section_header": "", + "field_type": "radio", + "field_label": "Worried that other people were judging me as a person because of my weight and appearance.", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not at all" + }, + { + "code": "1", + "label": "Rarely" + }, + { + "code": "2", + "label": "Occasionally" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "Most of the time" + }, + { + "code": "6", + "label": "All the time" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "ed15_matrix", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_11", + "form_name": "ed15", + "section_header": "", + "field_type": "text", + "field_label": "Over the past week, how many times have you binged (felt out of control of your eating, and eaten far more than a person normally would at one go)? If you have never used this behaviour, please respond with N/A.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_12", + "form_name": "ed15", + "section_header": "", + "field_type": "text", + "field_label": "Over the past week, how many times have you vomited to control your weight (using your fingers or medicines to make yourself sick, or vomiting without such aids), whether you had to make yourself sick or not? If you have never used this behaviour, please respond with N/A.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_13", + "form_name": "ed15", + "section_header": "", + "field_type": "text", + "field_label": "On how many days in the past week have you used laxatives to control your weight or shape? If you have never used the following behaviour, please respond with N/A.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_14", + "form_name": "ed15", + "section_header": "", + "field_type": "text", + "field_label": "On how many days in the past week have you restricted or dieted in order to control your weight? If you have never used the following behaviour, please respond with N/A.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed15_15", + "form_name": "ed15", + "section_header": "", + "field_type": "text", + "field_label": "On how many days in the past week have you exercised hard in order to control your weight? If you have never used the following behaviour, please respond with N/A.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "h_snapshot_instructions", + "form_name": "health_snapshot", + "section_header": "", + "field_type": "descriptive", + "field_label": "



Comfortable clothing and appropriate footwear should be worn for this test.



Instruction Video

\n

", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "h_snapshot_instructions_2", + "form_name": "health_snapshot", + "section_header": "", + "field_type": "info", + "field_label": "Health Snapshot Instructions", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Part 1, Please sit and use your Garmin watch to register a Health Snapshot." + }, + { + "code": "2", + "label": "Part 2, After having recorded the Health Snapshot on the watch, please press 'NEXT' below." + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "info-type", + "evaluated_logic": "" + }, + { + "field_name": "h_snapshot_date", + "form_name": "health_snapshot", + "section_header": "", + "field_type": "text", + "field_label": "Please enter the date that you took the health snapshot.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "datetime_dmy", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "esm_sleep_well_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "I slept well", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm1_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "" + }, + { + "field_name": "esm_cheerful_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "Right now, I feel cheerful", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + 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family or friends' place" + }, + { + "code": "2", + "label": "At work, school, university or college" + }, + { + "code": "3", + "label": "Travelling somewhere / in a vehicle" + }, + { + "code": "4", + "label": "In a healthcare facility" + }, + { + "code": "5", + "label": "Somewhere else indoors" + }, + { + "code": "6", + "label": "Somewhere else outdoors" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "esm_social_interact_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "checkbox", + "field_label": "Who am I with?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Alone" + }, + { + "code": "1", + "label": "Partner" + }, + { + "code": "2", + "label": "Relatives living with you" + }, + { + "code": "3", + "label": "Relatives not living with you" + }, + { + "code": "4", + "label": "House/room mates" + }, + { + "code": "5", + "label": "Friends" + }, + { + "code": "6", + "label": "Classmates/colleagues" + }, + { + "code": "7", + "label": "Caregiver(s)" + }, + { + "code": "8", + "label": "Strangers/others" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "esm_social_people_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "radio", + "field_label": "How many people am I with?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3-10" + }, + { + "code": "4", + "label": "over 10" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '1' or [esm_social_interact_story] = '2' or [esm_social_interact_story] = '3' or [esm_social_interact_story] = '4' or [esm_social_interact_story] = '5' or [esm_social_interact_story] = '6' or [esm_social_interact_story] = '7' or [esm_social_interact_story] = '8'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['esm_social_interact_story'] == '1' || responses['esm_social_interact_story'] == '2' || responses['esm_social_interact_story'] == '3' || responses['esm_social_interact_story'] == '4' || responses['esm_social_interact_story'] == '5' || responses['esm_social_interact_story'] == '6' || responses['esm_social_interact_story'] == '7' || responses['esm_social_interact_story'] == '8'" + }, + { + "field_name": "esm_social_compare", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "I am comparing how I look with the others around me right now.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '1' or [esm_social_interact_story] = '2' or [esm_social_interact_story] = '3' or [esm_social_interact_story] = '4' or [esm_social_interact_story] = '5' or [esm_social_interact_story] = '6' or [esm_social_interact_story] = '7' or [esm_social_interact_story] = '8'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm4_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['esm_social_interact_story'] == '1' || responses['esm_social_interact_story'] == '2' || responses['esm_social_interact_story'] == '3' || responses['esm_social_interact_story'] == '4' || responses['esm_social_interact_story'] == '5' || responses['esm_social_interact_story'] == '6' || responses['esm_social_interact_story'] == '7' || responses['esm_social_interact_story'] == '8'" + }, + { + "field_name": "esm_social_alone1", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "I would prefer to be alone.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '1' or [esm_social_interact_story] = '2' or [esm_social_interact_story] = '3' or [esm_social_interact_story] = '4' or [esm_social_interact_story] = '5' or [esm_social_interact_story] = '6' or [esm_social_interact_story] = '7' or [esm_social_interact_story] = '8'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm4_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['esm_social_interact_story'] == '1' || responses['esm_social_interact_story'] == '2' || responses['esm_social_interact_story'] == '3' || responses['esm_social_interact_story'] == '4' || responses['esm_social_interact_story'] == '5' || responses['esm_social_interact_story'] == '6' || responses['esm_social_interact_story'] == '7' || responses['esm_social_interact_story'] == '8'" + }, + { + "field_name": "esm_social_connected1", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "I feel connected to the people I am with.", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '1' or [esm_social_interact_story] = '2' or [esm_social_interact_story] = '3' or [esm_social_interact_story] = '4' or [esm_social_interact_story] = '5' or [esm_social_interact_story] = '6' or [esm_social_interact_story] = '7' or [esm_social_interact_story] = '8'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm4_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['esm_social_interact_story'] == '1' || responses['esm_social_interact_story'] == '2' || responses['esm_social_interact_story'] == '3' || responses['esm_social_interact_story'] == '4' || responses['esm_social_interact_story'] == '5' || responses['esm_social_interact_story'] == '6' || responses['esm_social_interact_story'] == '7' || responses['esm_social_interact_story'] == '8'" + }, + { + "field_name": "esm_social_ok_alone_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "I feel fine being alone", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm5_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['esm_social_interact_story'] == '0'" + }, + { + "field_name": "esm_social_others_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "I would prefer to be with others", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm5_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['esm_social_interact_story'] == '0'" + }, + { + "field_name": "esm_social_choice_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "Being alone right now is my choice", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm5_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['esm_social_interact_story'] == '0'" + }, + { + "field_name": "esm_social_left_out_story", + "form_name": "esm_story", + "section_header": "", + "field_type": "range", + "field_label": "I feel left out", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "1 Not at all" + }, + { + "code": "2", + "label": "2" + }, + { + "code": "3", + "label": "3" + }, + { + "code": "4", + "label": "4" + }, + { + "code": "5", + "label": "5" + }, + { + "code": "6", + "label": "6" + }, + { + "code": "7", + "label": "7 Very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[esm_social_interact_story] = '0'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "esm5_story", + "matrix_ranking": "", + "field_annotation": "range-type", + "evaluated_logic": "responses['esm_social_interact_story'] == '0'" + }, + { + "field_name": "bedtime_activities", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "descriptive", + "field_label": "Please have a look at these bedtime activities. On the next page, please write the order you do these using their letters. Leave out any you don't do. E.g. If you turn out the main light, get into bed, listen to music and then try to sleep, you'd write: ACEG.\n\n

A
Turn out the main light

B
Turn out the bedside light or other small light

C
Get into bed

D
Actively use my phone (e.g., look at social media, games/puzzles, read)

E
Passively use my phone (e.g., listen to music, listen to an audiobook, etc.)

F
Read a book or other activity not involving my phone

G
Shut my eyes and try to sleep

", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bedtime_activities_order", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "text", + "field_label": "Please write the letters for your bedtime activities here.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bedtime_activities_other", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "text", + "field_label": "Please describe anything about your sleep routine that is not captured in the previous question.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bedtime_phone_location", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "radio", + "field_label": "Where do you usually place your phone whilst you sleep?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Next to my pillow" + }, + { + "code": "1", + "label": "Bedside table or by my bed" + }, + { + "code": "2", + "label": "Elsewhere in my bedroom" + }, + { + "code": "3", + "label": "In another room" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "bedtime_phone", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bedtime_phone_charge", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Do you usually charge your phone overnight?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "bedtime_phone1", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "bedtime_alarm", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "matrix-radio", + "field_label": "Do you use an alarm on your phone to wake up?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "bedtime_phone1", + "matrix_ranking": "", + "field_annotation": "matrix-radio-type", + "evaluated_logic": "" + }, + { + "field_name": "bedtime_phone_snooze", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "radio", + "field_label": "How often do you press snooze on your phone alarm?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Every day" + }, + { + "code": "1", + "label": "Usually" + }, + { + "code": "2", + "label": "Sometimes" + }, + { + "code": "3", + "label": "Rarely" + }, + { + "code": "4", + "label": "Never" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "bedtime_phone2", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "bedtime_phone_mode", + "form_name": "sleep_routine", + "section_header": "", + "field_type": "radio", + "field_label": "What mode do you keep your phone in whilst you are asleep?", + "select_choices_or_calculations": [ + { + "code": "0", + "label": "Sound" + }, + { + "code": "1", + "label": "Vibrate" + }, + { + "code": "2", + "label": "Mute" + }, + { + "code": "3", + "label": "Airplane" + }, + { + "code": "4", + "label": "Switch off" + }, + { + "code": "5", + "label": "Do not disturb" + }, + { + "code": "6", + "label": "Other" + }, + { + "code": "7", + "label": "Unsure (Please ask researcher)" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "bedtime_phone3", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ed_motivation_1", + "form_name": "ed_motivation", + "section_header": "", + "field_type": "slider", + "field_label": "Right now, how motivated do you feel to start working on your eating difficulties?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "Not motivated at all", + "labelRight": "Extremely motivated" + }, + "evaluated_logic": "" + }, + { + "field_name": "ed_motivation_2", + "form_name": "ed_motivation", + "section_header": "", + "field_type": "slider", + "field_label": "Right now, how ready do you feel to start working on your eating difficulties?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "0", + "max": "100", + "step": 1, + "labelLeft": "Not ready at all", + "labelRight": "Extremely ready" + }, + "evaluated_logic": "" + }, + { + "field_name": "period", + "form_name": "period_pain_and_fatigue", + "section_header": "", + "field_type": "yesno", + "field_label": "Did you have your period today?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "menstrual_pain", + "form_name": "period_pain_and_fatigue", + "section_header": "", + "field_type": "radio", + "field_label": "How much were you bothered by pain related to your menstrual cycle today (i.e cramps)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[period] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['period'] == '1'" + }, + { + "field_name": "tired", + "form_name": "period_pain_and_fatigue", + "section_header": "", + "field_type": "radio", + "field_label": "How tired did you feel today?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "other_events_1", + "form_name": "period_pain_and_fatigue", + "section_header": "", + "field_type": "yesno", + "field_label": "Did any notable events or circumstances occur today that you think might have impacted your symptoms or overall well-being? This could involve changes in your daily routine (e.g. night shift work), heightened stressors (interpersonal stress, pain like a migraine), significant life events, or any other noteworthy incidents. ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "other_events_2", + "form_name": "period_pain_and_fatigue", + "section_header": "", + "field_type": "text", + "field_label": "Please provide details.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[other_events_1] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['other_events_1'] == '1'" + }, + { + "field_name": "asrs_1", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "Please answer the questions below, rating yourself on each of the criteria as shown on the right. Answer each question in a way that best describes how you have felt and conducted yourself today.", + "field_type": "radio", + "field_label": "Did you have trouble wrapping up a task or did you leave unfinished something you had planned to do?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_2", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have difficulty getting yourself organised/planning or organising your day?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_3", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have problems remembering appointments or things you were supposed to do (e.g. returning a call or text, opening mail)", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_4", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have trouble getting started/getting going on things?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_5", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you fidget or squirm with your hands or feet?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_6", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you feel overly active and compelled to do things, like you were driven by a motor?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_7", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you make careless mistakes?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_8", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have difficulty keeping your attention when you were doing something you weren't particularly interested in? [when you weren't motivated by the task]", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_9", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have difficulty paying attention to what people were saying to you, or did you 'zoning out' in conversation?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_10", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you misplace or have difficulty finding things at home or at work (e.g. mobile phone, house keys)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_11", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Were you distracted by activity or noise around you?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_12", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did your own thoughts distract you and prevent you from focusing?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_13", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you feel restless or fidgety? (this can also be a feeling of internal restlessness)", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_14", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you say things without thinking?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_15", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Did you make 'spur of the moment' decisions without really thinking things through?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_16", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "Was it hard for you to resist acting on your feelings?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_17", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "How much did you feel impatient waiting for something (e.g. at a stop light, in a queue)", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "A lot / often" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "adhd_impairment_1", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "To what extent do the problems you endorsed above interfere with your ability to function in each of these areas of life activities today?", + "field_type": "radio", + "field_label": "In your home life with your immediate family", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Very much / A lot" + }, + { + "code": "6", + "label": "Not applicable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "adhd_impairment", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "adhd_impairment_2", + "form_name": "adhd_symptoms_and_impairment", + "section_header": "", + "field_type": "radio", + "field_label": "In your work/occupation or educational activities", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Very much / A lot" + }, + { + "code": "6", + "label": "Not applicable" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": 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"text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_4_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_4_da'] == '1'" + }, + { + "field_name": "meduse_2c_5_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "text", + "field_label": "Medication 5: Time taken", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "time", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_4_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_4_da'] == '1'" + }, + { + "field_name": "meduse_2d_5_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Add another medication?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_4_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_4_da'] == '1'" + }, + { + "field_name": "meduse_2a_6_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Name of medication 6:", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Methylphenidate ER (Concerta XL, Ritalin XL, Medikinet XL, Equasym XL, Matoride XL, Xaggitin XL, Xenidate XL, Delmosart)" + }, + { + "code": "2", + "label": "Methylphenidate IR (Ritalin, Medikinet IR)" + }, + { + "code": "3", + "label": "Lisdexamfetamine (Amfexa, Elvanse/Elvanse adult)" + }, + { + "code": "4", + "label": "Dexamfetamine IR" + }, + { + "code": "5", + "label": "Atomoxetine (Strattera)" + }, + { + "code": "6", + "label": "Bupropion (Zyban)" + }, + { + "code": "7", + "label": "Guanfacine ER (Intuniv)" + }, + { + "code": "8", + "label": "Tranquilyn" + }, + { + "code": "9", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_5_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_5_da'] == '1'" + }, + { + "field_name": "meduse_2a_6o_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "text", + "field_label": "If other, please type in name of medication 6: ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2a_6_da] = '9'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2a_6_da'] == '9'" + }, + { + "field_name": "meduse_2b_6_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "text", + "field_label": "Medication 6: Dose (in mg)", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_5_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_5_da'] == '1'" + }, + { + "field_name": "meduse_2c_6_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "text", + "field_label": "Medication 6: Time taken", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "time", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_5_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_5_da'] == '1'" + }, + { + "field_name": "med_effectiveness_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "checkbox", + "field_label": "How do you feel your medication is working today?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not as well as usual" + }, + { + "code": "2", + "label": "The same as usual" + }, + { + "code": "3", + "label": "Better than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_1_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_1_da'] == '1'" + }, + { + "field_name": "period_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "yesno", + "field_label": "Did you have your period today?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "period_pain_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "slider", + "field_label": "How much were you bothered by pain related to your menstrual cycle today (i.e. cramps)?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[period_da] = '1'", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "1", + "max": "5", + "step": 1, + "labelLeft": "Not at all", + "labelRight": "Extremely" + }, + "evaluated_logic": "responses['period_da'] == '1'" + }, + { + "field_name": "fatigue_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "slider", + "field_label": "How tired did you feel today?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "1", + "max": "5", + "step": 1, + "labelLeft": "Not at all", + "labelRight": "Extremely" + }, + "evaluated_logic": "" + }, + { + "field_name": "other_events_1_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "yesno", + "field_label": "Did any notable events or circumstances occur today that you think might have impacted your symptoms or overall well-being? This could involve changes in your daily routine (e.g. night shift work), heightened stressors (interpersonal stress, pain like a migraine), significant life events, or any other noteworthy incidents. ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "other_events_2_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "text", + "field_label": "Please provide details.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[other_events_1_da] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['other_events_1_da'] == '1'" + }, + { + "field_name": "asrs_1_da", + "form_name": "maam_day_a", + "section_header": "Please answer the questions below, answering each question in a way that best describes how you have felt and conducted yourself today.", + "field_type": "radio", + "field_label": "Did you have trouble wrapping up a task or leaving something unfinished?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_2_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have a hard time getting organised or planning your day?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_3_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have problems remembering appointments or things you were meant to do (e.g. returning a call/text, opening mail)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_4_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have trouble getting started/getting going on things?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_5_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you fidget or squirm with your hands or feet?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_6_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you feel overly active, like you were driven by a motor?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_7_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you make careless mistakes?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_8_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have a hard time paying attention when doing something boring/you weren't interested in?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_9_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you have difficulty paying attention to what people were saying to you ('zoning out' in conversation)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_10_dab", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Did you misplace or have difficulty finding things (e.g. mobile phone, keys)?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "asrs_da", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "asrs_11_da", + "form_name": "maam_day_a", + "section_header": "", + "field_type": "radio", + "field_label": "Were you distracted by activity or noise around you?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Never / not at all" + }, + { + "code": "2", + "label": "Rarely / a little bit" + }, + { + "code": "3", + "label": "Sometimes / moderately" + }, + { + "code": "4", + "label": "Often / a lot" + }, + { + "code": "5", + "label": "Almost always / very much" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": 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"field_type": "text", + "field_label": "Medication 4: Dose (in mg)", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_3_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_3_db'] == '1'" + }, + { + "field_name": "meduse_2c_4_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "Medication 4: Time taken", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "time", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_3_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": 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"select_choices_or_calculations": [ + { + "code": "1", + "label": "Methylphenidate ER (Concerta XL, Ritalin XL, Medikinet XL, Equasym XL, Matoride XL, Xaggitin XL, Xenidate XL, Delmosart)" + }, + { + "code": "2", + "label": "Methylphenidate IR (Ritalin, Medikinet IR)" + }, + { + "code": "3", + "label": "Lisdexamfetamine (Amfexa, Elvanse/Elvanse adult)" + }, + { + "code": "4", + "label": "Dexamfetamine IR" + }, + { + "code": "5", + "label": "Atomoxetine (Strattera)" + }, + { + "code": "6", + "label": "Bupropion (Zyban)" + }, + { + "code": "7", + "label": "Guanfacine ER (Intuniv)" + }, + { + "code": "8", + "label": "Tranquilyn" + }, + { + "code": "9", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_4_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_4_db'] == '1'" + }, + { + "field_name": "meduse_2a_5o_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "If other, please type in name of medication 5: ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2a_5_db] = '9'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2a_5_db'] == '9'" + }, + { + "field_name": "meduse_2b_5_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "Medication 5: Dose (in mg)", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_4_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_4_db'] == '1'" + }, + { + "field_name": "meduse_2c_5_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "Medication 5: Time taken", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "time", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_4_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_4_db'] == '1'" + }, + { + "field_name": "meduse_2d_5_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "radio", + "field_label": "Add another medication?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Yes" + }, + { + "code": "0", + "label": "No" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_4_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_4_db'] == '1'" + }, + { + "field_name": "meduse_2a_6_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "radio", + "field_label": "Name of medication 6:", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Methylphenidate ER (Concerta XL, Ritalin XL, Medikinet XL, Equasym XL, Matoride XL, Xaggitin XL, Xenidate XL, Delmosart)" + }, + { + "code": "2", + "label": "Methylphenidate IR (Ritalin, Medikinet IR)" + }, + { + "code": "3", + "label": "Lisdexamfetamine (Amfexa, Elvanse/Elvanse adult)" + }, + { + "code": "4", + "label": "Dexamfetamine IR" + }, + { + "code": "5", + "label": "Atomoxetine (Strattera)" + }, + { + "code": "6", + "label": "Bupropion (Zyban)" + }, + { + "code": "7", + "label": "Guanfacine ER (Intuniv)" + }, + { + "code": "8", + "label": "Tranquilyn" + }, + { + "code": "9", + "label": "Other" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_5_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_5_db'] == '1'" + }, + { + "field_name": "meduse_2a_6o_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "If other, please type in name of medication 6: ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2a_6_db] = '9'", + "required_field": "", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2a_6_db'] == '9'" + }, + { + "field_name": "meduse_2b_6_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "Medication 6: Dose (in mg)", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "number", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_5_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_5_db'] == '1'" + }, + { + "field_name": "meduse_2c_6_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "Medication 6: Time taken", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "time", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_2d_5_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_2d_5_db'] == '1'" + }, + { + "field_name": "med_effectiveness_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "checkbox", + "field_label": "How do you feel your medication is working today?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not as well as usual" + }, + { + "code": "2", + "label": "The same as usual" + }, + { + "code": "3", + "label": "Better than usual" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[meduse_1_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['meduse_1_db'] == '1'" + }, + { + "field_name": "period_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "yesno", + "field_label": "Did you have your period today?", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "period_pain_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "slider", + "field_label": "How much were you bothered by pain related to your menstrual cycle today (i.e. cramps)?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[period_db] = '1'", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "1", + "max": "5", + "step": 1, + "labelLeft": "Not at all", + "labelRight": "Extremely" + }, + "evaluated_logic": "responses['period_db'] == '1'" + }, + { + "field_name": "tired_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "slider", + "field_label": "How tired did you feel today?", + "select_choices_or_calculations": [], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "RH", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "range": { + "min": "1", + "max": "5", + "step": 1, + "labelLeft": "Not at all", + "labelRight": "Extremely" + }, + "evaluated_logic": "" + }, + { + "field_name": "other_events_1_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "yesno", + "field_label": "Did any notable events or circumstances occur today that you think might have impacted your symptoms or overall well-being? This could involve changes in your daily routine (e.g. night shift work), heightened stressors (interpersonal stress, pain like a migraine), significant life events, or any other noteworthy incidents. ", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "other_events_2_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "text", + "field_label": "Please provide details.", + "select_choices_or_calculations": "", + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "[other_events_1_db] = '1'", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "responses['other_events_1_db'] == '1'" + }, + { + "field_name": "phq_8_1_db", + "form_name": "maam_day_b", + "section_header": "Today, how much have you been bothered by any of the following problems?", + "field_type": "radio", + "field_label": "Little interest or pleasure in doing things", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq_8_db", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "phq_8_2_db", + "form_name": "maam_day_b", + "section_header": "", + "field_type": "radio", + "field_label": "Feeling down, depressed, or hopeless", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "phq_8_db", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "ari_self_1_db", + "form_name": "maam_day_b", + "section_header": "How well does each of the following statements describe your behaviour/feelings today?", "field_type": "radio", - "field_label": "1. Do you use olive oil as main culinary fat?", + "field_label": "I am easily annoyed by others", "select_choices_or_calculations": [ + { + "code": "0", + "label": "Not True" + }, { "code": "1", - "label": "Yes" + "label": "Somewhat True" }, { - "code": "0", - "label": "No" + "code": "2", + "label": "Certainly True" } ], "field_note": "", @@ -24,63 +37947,71 @@ "required_field": "y", "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "ari_self_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_2", - "form_name": "mediterranean_diet_adherence", + "field_name": "ari_self_2_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "2. How much olive oil do you consume in a given day (in tbsp) (including oil used for frying, salads, out-of-house meals, etc.) ? ", + "field_type": "radio", + "field_label": "I often lose my temper", "select_choices_or_calculations": [ { "code": "0", - "label": "0 tbsp" + "label": "Not True" }, { - "code": "5", - "label": "5 tbsp" + "code": "1", + "label": "Somewhat True" }, { - "code": "10+", - "label": "10+ tbsp" + "code": "2", + "label": "Certainly True" } ], - "field_note": "tbsp", + "field_note": "", "text_validation_type_or_show_slider_number": "", "text_validation_min": "", "text_validation_max": "", "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "ari_self_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_3", - "form_name": "mediterranean_diet_adherence", - "section_header": "", - "field_type": "slider", - "field_label": "How many vegetable servings do you consume per day? \n(1 serving : 200g [consider side dishes as half a serving])", + "field_name": "neuro_qol_1_db", + "form_name": "maam_day_b", + "section_header": "Today, how much have you been bothered by any of the following problems? ", + "field_type": "radio", + "field_label": "I made simple mistakes more easily", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 servings" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 servings" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" }, { - "code": "10+", - "label": "10+ servings" + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -90,31 +38021,39 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_4", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_2_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "4. How many fruit units (including natural fruit juices) do you consume per day?", + "field_type": "radio", + "field_label": "Words I wanted to use seemed to be on the \"tip of my tongue\"", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 units" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 units" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" }, { - "code": "10+", - "label": "10+ units" + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -124,31 +38063,39 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_5", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_3_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "5. How many servings of red meat, hamburger, or meat products (ham, sausage, etc.) do you consume per day?\n(1 serving: 100-150g)", + "field_type": "radio", + "field_label": "I had difficulty doing more than one thing at a time", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 servings" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 servings" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" }, { - "code": "10+", - "label": "10+ servings" + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -158,31 +38105,39 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_6", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_4_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "6. How many servings of butter, margarine, or cream do you consume per day? \n(1 serving: 12g)", + "field_type": "radio", + "field_label": "I had trouble remembering whether I did things I was supposed to do, like taking a medicine or buying something I needed", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 servings" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 servings" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" }, { - "code": "10+", - "label": "10+ servings" + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -192,31 +38147,39 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_7", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_5_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "7. How many sweet or carbonated beverages do you drink per day?", + "field_type": "radio", + "field_label": "I had trouble thinking clearly", "select_choices_or_calculations": [ { - "code": "0", - "label": "0" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" }, { - "code": "10+", - "label": "10+" + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -226,65 +38189,81 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_6_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "8. How much wine do you drink per week? (in glasses)", + "field_type": "radio", + "field_label": "I had to work really hard to pay attention or I would make a mistake", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 glasses" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 glasses" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" }, { - "code": "10+", - "label": "10+ glasses" + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" } ], - "field_note": "glasses", + "field_note": "", "text_validation_type_or_show_slider_number": "", "text_validation_min": "", "text_validation_max": "", "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_9", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_7_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "9. How many servings of legumes do you consume per week? \r\n(1 serving: 150g)", + "field_type": "radio", + "field_label": "I had trouble getting started on very simple tasks", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 servings" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 servings" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" }, { - "code": "10+", - "label": "10+ servings" + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -294,31 +38273,39 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_10", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_8_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "10. How many servings of fish or shellfish do you consume per week?\n(1 serving 100-150g of fish or 4-5 units or 200g of shellfish)", + "field_type": "radio", + "field_label": "I had trouble making decisions", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 servings" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 servings" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" }, { - "code": "10+", - "label": "10+ servings" + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -328,31 +38315,39 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_11", - "form_name": "mediterranean_diet_adherence", + "field_name": "neuro_qol_9_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "11. How many times per week do you consume commercial sweets or pastries (not homemade), such as cakes, cookies, biscuits, or custard?", + "field_type": "radio", + "field_label": "I had trouble planning out steps of a task", "select_choices_or_calculations": [ { - "code": "0", - "label": "0 times" + "code": "1", + "label": "Not at all" }, { - "code": "5", - "label": "5 times" + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" }, { - "code": "10+", - "label": "10+ times" + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -362,27 +38357,41 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "neuro_qol_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_12", - "form_name": "mediterranean_diet_adherence", - "section_header": "", - "field_type": "slider", - "field_label": "12. How many servings of nuts (including peanuts) do you consume per week?\n(1 serving 30g)", - "select_choices_or_calculations": [], - "range": { - "min": "0", - "max": "10", - "step": "1", - "labelLeft": "0 servings", - "labelRight": "10+ servings" - }, + "field_name": "sensitivity_1_db", + "form_name": "maam_day_b", + "section_header": "Please answer each question according to the way you felt today.", + "field_type": "radio", + "field_label": "Did you find yourself needing to withdraw into a place where you can have some privacy and relief from stimulation?", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely/ a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" + }, + { + "code": "5", + "label": "A lot/ very much/ always always" + } + ], "field_note": "", "text_validation_type_or_show_slider_number": "", "text_validation_min": "", @@ -390,39 +38399,81 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "sensitivity_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_13", - "form_name": "mediterranean_diet_adherence", + "field_name": "sensitivity_2_db", + "form_name": "maam_day_b", "section_header": "", "field_type": "radio", - "field_label": "13. Do you preferentially consume chicken, turkey, or rabbit meat instead of veal, pork, hamburger or sausage?", + "field_label": "Were you easily overwhelmed by things like bright lights, strong smells, coarse fabrics, or loud or irritating noises?", "select_choices_or_calculations": [ { - "code": "0", - "label": "No" + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "Rarely/ a little bit" + }, + { + "code": "3", + "label": "Sometimes" + }, + { + "code": "4", + "label": "Often" }, + { + "code": "5", + "label": "A lot/ very much/ always always" + } + ], + "field_note": "", + "text_validation_type_or_show_slider_number": "", + "text_validation_min": "", + "text_validation_max": "", + "identifier": "", + "branching_logic": "", + "required_field": "y", + "custom_alignment": "", + "question_number": "", + "matrix_group_name": "sensitivity_db", + "matrix_ranking": "", + "field_annotation": "", + "evaluated_logic": "" + }, + { + "field_name": "emotion_dysregulation_1_db", + "form_name": "maam_day_b", + "section_header": "Today, how much have you been bothered by any of the following problems?", + "field_type": "radio", + "field_label": "My emotions felt overwhelming and out of control", + "select_choices_or_calculations": [ { "code": "1", - "label": "Yes" + "label": "Not at all" }, { "code": "2", - "label": "N/A Vegetarian" + "label": "A little bit" }, { "code": "3", - "label": "N/A Vegan" + "label": "Moderately" }, { "code": "4", - "label": "N/A Pescatarian" + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" } ], "field_note": "", @@ -434,25 +38485,39 @@ "required_field": "y", "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "emotion_dysregulation_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": "" }, { - "field_name": "med_14", - "form_name": "mediterranean_diet_adherence", + "field_name": "emotion_dysregulation_2_db", + "form_name": "maam_day_b", "section_header": "", - "field_type": "slider", - "field_label": "14. How many times per week do you consume vegetables, pasta, rice, or other dishes seasoned with sofrito (sauce made with tomato and onion, leek, or garlic and simmered with olive oil)?", - "select_choices_or_calculations": [], - "range": { - "min": "0", - "max": "10", - "step": "1", - "labelLeft": "0 times", - "labelRight": "10+ times" - }, + "field_type": "radio", + "field_label": "My feelings changed quickly - I felt one way in one minute and totally different in the next", + "select_choices_or_calculations": [ + { + "code": "1", + "label": "Not at all" + }, + { + "code": "2", + "label": "A little bit" + }, + { + "code": "3", + "label": "Moderately" + }, + { + "code": "4", + "label": "Quite a bit" + }, + { + "code": "5", + "label": "Extremely" + } + ], "field_note": "", "text_validation_type_or_show_slider_number": "", "text_validation_min": "", @@ -460,9 +38525,9 @@ "identifier": "", "branching_logic": "", "required_field": "y", - "custom_alignment": "RH", + "custom_alignment": "", "question_number": "", - "matrix_group_name": "", + "matrix_group_name": "emotion_dysregulation_db", "matrix_ranking": "", "field_annotation": "", "evaluated_logic": ""