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@Hasstrup
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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