Created
April 29, 2020 22:13
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{ | |
"questions": { | |
"Onset Symptoms": [ | |
{ | |
"question": "Do you have a fever or a history of fever?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "Specify max temperature?", | |
"options": "STRING_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Do you have a sore throat?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Do you have a runny nose?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Do you have shortness of breath?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Chills", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Vomitting", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Diarrhoea", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Headache", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Rash", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
} | |
], | |
"Symptoms: Complications": [ | |
{ | |
"question": "Hospitalization", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "ICU", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Mechanical Ventilation", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Acute Respiratory Distress Syndrome", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Acute Renal Failure", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Cardiac Failure", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Comsuptive Coagulopathy", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Pneumonia by Chest X-ray", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Other Complications", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Hypotension requiring vasopressors", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "EMO required", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
} | |
], | |
"Pre-existing conditions": [ | |
{ | |
"question": "Pregnancy", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Obesity", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Cancer", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Diabetes HIV/other Immune deficiency", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Heart Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Asthma", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Lung Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Liver Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Haematological Disorder", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Kidney Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic neurological impairment/disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Organ/bone marrow recipient", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Other", | |
"options": "STRING_TYPE" | |
} | |
], | |
"Exposure": [ | |
{ | |
"question": "Travelled Domestically", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "From", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "To", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "State", | |
"options": "SELECT(State)" | |
}, | |
{ | |
"question": "City", | |
"options": "SELECT(State.City)" | |
}, | |
{ | |
"question": "LGA", | |
"options": "SELECT(State.City.LGA)" | |
} | |
] | |
}, | |
{ | |
"question": "Travelled Internationally", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "From", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "To", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "State", | |
"options": "SELECT(State)" | |
}, | |
{ | |
"question": "City", | |
"options": "SELECT(State.City)" | |
}, | |
{ | |
"question": "LGA", | |
"options": "SELECT(State.City.LGA)" | |
} | |
] | |
}, | |
{ | |
"question": "In the past 14 days, have you had contact with anyone with suspected or confirmed COVID-19 infection?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "Dates of last contact", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Patient attended festival or mass gatherings in the past 14 days", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "Specify", | |
"options": "STRING_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Patient exposed to person with similar illness in the past 14 days", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
} | |
] | |
} | |
} | |
{ | |
"questions": { | |
"Onset Symptoms": [ | |
{ | |
"question": "Do you have a fever or a history of fever?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "Specify max temperature?", | |
"options": "STRING_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Do you have a sore throat?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Do you have a runny nose?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Do you have shortness of breath?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "When did it start?", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Chills", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Vomitting", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Diarrhoea", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Headache", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Rash", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
} | |
], | |
"Symptoms: Complications": [ | |
{ | |
"question": "Hospitalization", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "ICU", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Mechanical Ventilation", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Acute Respiratory Distress Syndrome", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Acute Renal Failure", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Cardiac Failure", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Comsuptive Coagulopathy", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Pneumonia by Chest X-ray", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Other Complications", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Hypotension requiring vasopressors", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "EMO required", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
} | |
], | |
"Pre-existing conditions": [ | |
{ | |
"question": "Pregnancy", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Obesity", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Cancer", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Diabetes HIV/other Immune deficiency", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Heart Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Asthma", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Lung Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Liver Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Haematological Disorder", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic Kidney Disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Chronic neurological impairment/disease", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Organ/bone marrow recipient", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
}, | |
{ | |
"question": "Other", | |
"options": "STRING_TYPE" | |
} | |
], | |
"Exposure": [ | |
{ | |
"question": "Travelled Domestically", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "From", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "To", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "State", | |
"options": "SELECT(State)" | |
}, | |
{ | |
"question": "City", | |
"options": "SELECT(State.City)" | |
}, | |
{ | |
"question": "LGA", | |
"options": "SELECT(State.City.LGA)" | |
} | |
] | |
}, | |
{ | |
"question": "Travelled Internationally", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "From", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "To", | |
"options": "DATE_TYPE" | |
}, | |
{ | |
"question": "State", | |
"options": "SELECT(State)" | |
}, | |
{ | |
"question": "City", | |
"options": "SELECT(State.City)" | |
}, | |
{ | |
"question": "LGA", | |
"options": "SELECT(State.City.LGA)" | |
} | |
] | |
}, | |
{ | |
"question": "In the past 14 days, have you had contact with anyone with suspected or confirmed COVID-19 infection?", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "Dates of last contact", | |
"options": "DATE_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Patient attended festival or mass gatherings in the past 14 days", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
], | |
"children": [ | |
{ | |
"question": "Specify", | |
"options": "STRING_TYPE" | |
} | |
] | |
}, | |
{ | |
"question": "Patient exposed to person with similar illness in the past 14 days", | |
"options": [ | |
"Yes", | |
"No", | |
"Unknown" | |
] | |
} | |
] | |
} | |
} |
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