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KHP3-4003 Generalized anxiety disorder assessment form (#159)
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configuration/ampathforms/Generalized_Anxiety_Disorder.json
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| { | ||
| "name": "Generalized Anxiety Disorder Assessment", | ||
| "description": "Generalized Anxiety Disorder Assessment", | ||
| "version": "1.0", | ||
| "published": true, | ||
| "uuid": "524d078e-936a-4543-9ca6-7a8d9ed4db06", | ||
| "retired": false, | ||
| "encounter": "Generalized Anxiety Disorder Assessment", | ||
| "pages": [ | ||
| { | ||
| "label": "Generalized Anxiety Disorder Assessment", | ||
| "sections": [ | ||
| { | ||
| "label": "Visit Details", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Date:", | ||
| "type": "encounterDatetime", | ||
| "questionOptions": { | ||
| "rendering": "ui-select-extended" | ||
| }, | ||
| "id": "encDate", | ||
| "validators": [ | ||
| { | ||
| "type": "date", | ||
| "allowFutureDates": "false" | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "label": "Provider:", | ||
| "type": "encounterProvider", | ||
| "questionOptions": { | ||
| "rendering": "ui-select-extended" | ||
| }, | ||
| "id": "encProvider " | ||
| }, | ||
| { | ||
| "label": "Location:", | ||
| "type": "encounterLocation", | ||
| "questionOptions": { | ||
| "rendering": "ui-select-extended" | ||
| }, | ||
| "id": "encLocation" | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "label": "Over the last 2 weeks, how often have you been bothered by any of the following problems?", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "Feeling nervous, anxious or on edge", | ||
| "type": "obs", | ||
| "id": "feelingNervousAnxious", | ||
| "questionOptions": { | ||
| "concept": "167003AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Not at all" | ||
| }, | ||
| { | ||
| "concept": "167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Several days " | ||
| }, | ||
| { | ||
| "concept": "167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "More than half the days" | ||
| }, | ||
| { | ||
| "concept": "167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nearly every day" | ||
| } | ||
| ] | ||
| } | ||
| }, | ||
| { | ||
| "label": "Not being able to stop or control worrying", | ||
| "type": "obs", | ||
| "id": "stopOrControlWorrying", | ||
| "questionOptions": { | ||
| "concept": "167005AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Not at all" | ||
| }, | ||
| { | ||
| "concept": "167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Several days " | ||
| }, | ||
| { | ||
| "concept": "167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "More than half the days" | ||
| }, | ||
| { | ||
| "concept": "167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nearly every day" | ||
| } | ||
| ] | ||
| } | ||
| }, | ||
| { | ||
| "label": "Worrying too much about different things", | ||
| "type": "obs", | ||
| "id": "worryingTooMuch", | ||
| "questionOptions": { | ||
| "concept": "166482AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Not at all" | ||
| }, | ||
| { | ||
| "concept": "167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Several days " | ||
| }, | ||
| { | ||
| "concept": "167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "More than half the days" | ||
| }, | ||
| { | ||
| "concept": "167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nearly every day" | ||
| } | ||
| ] | ||
| } | ||
| }, | ||
| { | ||
| "label": "Trouble Relaxing", | ||
| "type": "obs", | ||
| "id": "troubleRelaxing", | ||
| "questionOptions": { | ||
| "concept": "167064AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Not at all" | ||
| }, | ||
| { | ||
| "concept": "167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Several days " | ||
| }, | ||
| { | ||
| "concept": "167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "More than half the days" | ||
| }, | ||
| { | ||
| "concept": "167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nearly every day" | ||
| } | ||
| ] | ||
| } | ||
| }, | ||
| { | ||
| "label": "Being so restless that it is hard to sit still", | ||
| "type": "obs", | ||
| "id": "tooRestless", | ||
| "questionOptions": { | ||
| "concept": "167065AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Not at all" | ||
| }, | ||
| { | ||
| "concept": "167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Several days " | ||
| }, | ||
| { | ||
| "concept": "167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "More than half the days" | ||
| }, | ||
| { | ||
| "concept": "167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nearly every day" | ||
| } | ||
| ] | ||
| } | ||
| }, | ||
| { | ||
| "label": "Feeling bad about yourself, or that you are a failure,or that you have let yourself or your family down", | ||
| "type": "obs", | ||
| "id": "feelingBadAboutYourself", | ||
| "questionOptions": { | ||
| "concept": "167066AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Not at all" | ||
| }, | ||
| { | ||
| "concept": "167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Several days " | ||
| }, | ||
| { | ||
| "concept": "167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "More than half the days" | ||
| }, | ||
| { | ||
| "concept": "167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nearly every day" | ||
| } | ||
| ] | ||
| } | ||
| }, | ||
| { | ||
| "label": "Feeling afraid as if something awful might happen", | ||
| "type": "obs", | ||
| "id": "feelingAfraid", | ||
| "questionOptions": { | ||
| "concept": "167067AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "160215AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Not at all" | ||
| }, | ||
| { | ||
| "concept": "167000AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Several days " | ||
| }, | ||
| { | ||
| "concept": "167001AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "More than half the days" | ||
| }, | ||
| { | ||
| "concept": "167002AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Nearly every day" | ||
| } | ||
| ] | ||
| } | ||
| } | ||
| ] | ||
| }, | ||
| { | ||
| "label": "Anxiety Assessment Score", | ||
| "isExpanded": "true", | ||
| "questions": [ | ||
| { | ||
| "label": "GAD 7 Rating", | ||
| "type": "obs", | ||
| "id": "gad7", | ||
| "questionOptions": { | ||
| "concept": "167267AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "rendering": "radio", | ||
| "answers": [ | ||
| { | ||
| "concept": "159410AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Minimal Anxiety" | ||
| }, | ||
| { | ||
| "concept": "1498AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Mild Anxiety" | ||
| }, | ||
| { | ||
| "concept": "1499AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Moderate Anxiety" | ||
| }, | ||
| { | ||
| "concept": "1500AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA", | ||
| "label": "Severe Anxiety" | ||
| } | ||
| ] | ||
| } | ||
| } | ||
| ] | ||
| } | ||
| ], | ||
| "processor": "EncounterFormProcessor", | ||
| "referencedForms": [] | ||
| } | ||
| ] | ||
| } |