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Inshal
2024-10-25 01:05:27 +05:00
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database/migrations/questionires.php Normal file
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<?php
$questionArray = [
"Regarding testosterone abnormality" => [
"When/why did you become concerned about testosterone abnormality" => "text",
"When were testosterone levelsfirst measured (levels?)" => "text"
],
"When testosterone was first measured had you previously taken or were taking" => [
"prescription pain medication" => ["radio" => ["yes", "no"]],
"muscle building supplements or steroids" => ["radio" => ["yes", "no"]],
"testosterone supplements/medications" => ["radio" => ["yes", "no"]]
],
"Regarding sexual function" => [
"Haslibido (sex drive) changed" => ["radio" => ["yes", "no"]],
"Has erectile function changed" => ["radio" => ["yes", "no"]],
"Have you used erection medications (What? How Long? Success?) describe" => "text"
],
"Regarding fertility" => [
"Do you have biological children" => ["radio" => ["yes", "no"]],
"Have you needed fertility assistance for pregnancy" => ["radio" => ["yes", "no"]],
"Are you hoping to have more children" => ["radio" => ["yes", "no", "maybe"]]
],
"Regarding factors that may indicate a problem that can contribute to testosterone problems have you had" => [
"Abnormal timing or issues with puberty" => ["radio" => ["yes", "no"]],
"History of undescended or twisted testicle" => ["radio" => ["yes", "no"]],
"History of testicular trauma or infections" => ["radio" => ["yes", "no"]],
"History of brain trauma, concussion, or stroke" => ["radio" => ["yes", "no"]],
"History of chemotherapy or radiation therapy" => ["radio" => ["yes", "no"]],
"Issues with snoring" => ["radio" => ["yes", "no"]],
"Prior Sleep apnea evaluation" => ["radio" => ["yes", "no"]],
"Family members with low testosterone NO/YES: (Who?)" => "text",
"Family members with fertility problems NO/YES: (Who?)" => "text"
],
"Regarding prostate health" => [
"Have you a rectal prostate exam NO/YES: If yes, last was when?abnormal?" => "text",
"Have you had PSA blood testingNO/YES: If yes, last was when? Abnormal?" => "text",
],
"<b>PERSONAL MEDICAL HISTORY</b> (indicate if you have the following with YEAR OF DIAGNOSIS)" => [
"High Blood if yes (Year of Diagnosis/ Details)" => "text",
"High Cholesterol if yes (Year of Diagnosis/ Details)" => "text",
"Heart Attack if yes (Year of Diagnosis/ Details)" => "text",
"Stroke if yes (Year of Diagnosis/ Details)" => "text",
"Atrial Fibrillation if yes (Year of Diagnosis/ Details)" => "text",
"Celiac Disease if yes (Year of Diagnosis/ Details)" => "text",
"Cancer if yes (Year of Diagnosis/ Details)" => "text",
"Depression / Anxiety if yes (Year of Diagnosis/ Details)" => "text",
"Kidney Disease if yes (Year of Diagnosis/ Details)" => "text",
"Kidney Stones if yes (Year of Diagnosis/ Details)" => "text",
"Osteoporosis if yes (Year of Diagnosis/ Details)" => "text",
"Broken Bone if yes (Year of Diagnosis/ Details)" => "text",
"Liver problems/Hepatitis if yes (Year of Diagnosis/ Details)" => "text",
"Bleeding Problems if yes (Year of Diagnosis/ Details)" => "text",
"Intestinal Problems if yes (Year of Diagnosis/ Details)" => "text",
"Thyroid Problem if yes (Year of Diagnosis/ Details)" => "text",
"Emphysema/COPD if yes (Year of Diagnosis/ Details)" => "text",
"Asthma if yes (Year of Diagnosis/ Details)" => "text",
"Smoking if yes (Year of Diagnosis/ Details)" => "text",
"Alcoholism if yes (Year of Diagnosis/ Details)" => "text",
"Other Problems " => "text"
],
"SURGICAL HISTORY " => [
"Elevated PSA" => ["radio" => ['yes', 'no']],
"Trouble passing urine" => ["radio" => ['yes', 'no']],
"Taking medicine for prostate or male-pattern balding" => ["radio" => ['yes', 'no']],
"History of anemia" => ["radio" => ['yes', 'no']],
"Vasectomy" => ["radio" => ['yes', 'no']],
"Erectile dysfunction" => ["radio" => ['yes', 'no']],
"Testicular or prostate cancer" => ["radio" => ['yes', 'no']],
"Prostate enlargement or BPH" => ["radio" => ['yes', 'no']],
"Kidney disease or decreased kidney function" => ["radio" => ['yes', 'no']],
"Frequent blood donations" => ["radio" => ['yes', 'no']],
"Non-cancerous testicular or prostate surgery" => ["radio" => ['yes', 'no']],
"Severe snoring" => ["radio" => ['yes', 'no']],
"Taking medicine for high cholesterol" => ["radio" => ['yes', 'no']],
],
"Birth Control Method" => [
"planning pregnancy in the next year" => "checkbox",
"Depend on partner’s contraception" => "checkbox",
"Vasectomy" => "checkbox",
"Condoms" => "checkbox",
"Other" => "text"
],
"Activity Level" => [
"Low – sedentary" => "checkbox",
"Moderate – walk/jog/workout infrequently" => "checkbox",
"Average – walk/jog/workout 1 to 3 times per week" => "checkbox",
"High – walk/jog/workout regularly 4+ times per week" => "checkbox"
],
"SOCIAL HISTORY" => [
"Tobacco Use" => ["radio" => ["yes", "no", "quit"]],
"Alcohol Use" => ["radio" => ["yes", "no", "quit"]],
"Alcohol Use" => ["radio" => ["yes", "no", "quit"]],
"Marital Status" => ["radio" => ["single", "married", "separated", "domestic partner", "others"]],
"Sexually Active" => ["radio" => ["yes", "no", "not currently"]],
"Current partner is" => ["radio" => ["yes", "no", "quit"]],
"Birth control method (if applicable)" => "text",
"Retired?" => ["radio" => ["yes", "no"]],
"Current or Past Occupation" => "text",
"Current or Past Occupation" => "text"
],
"ALLERGIES" => [
"MEDICATION ALLERGIES / INTOLERANCES" => "textarea",
"Have you ever had any issues with local anesthesia?" => ["radio" => ['yes', 'no']],
"Do you have a latex allergy?" => ["radio" => ['yes', 'no']],
"Do you have a latex allergy?" => "text",
"Current hormone replacement? if yes what?" => "text",
"Past hormone replacement therapy" => "text"
],
"MEDICATIONS" => [
"CURRENT MEDICATIONS" => 'textarea'
],
"Family history" => [
"Heart disease" => ["radio" => ['yes', 'no']],
"Diabetes" => ["radio" => ['yes', 'no']],
"Osteoporosis" => ["radio" => ['yes', 'no']],
"Alzheimer’s/dementia" => ["radio" => ['yes', 'no']],
"Breast cancer" => ["radio" => ['yes', 'no']],
"Other" => "text"
],
"HEALTH ASSESSMENT SYMPTOMS" => [
"Sweating (night sweats or excessive sweating)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Sleep problems (difficulty falling asleep, sleeping through the night or waking up too early)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Increased need for sleep or falls asleep easily after a meal" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Depressive mood (feeling down, sad, lack of drive)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Irritability (mood swings, feeling aggressive, angers easily)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Anxiety (inner restlessness, feeling panicked, feeling nervous, inner tension)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Physical exhaustion (general decrease in muscle strength or endurance, decrease in work performance, fatigue, lack of energy, stamina or motivation)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Sexual problems (change in sexual desire or in sexual performance)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Bladder problems (difficulty in urinating, increased need to urinate)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Erectile changes (weaker erections, loss of morning erections)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Joint and muscular symptoms (joint pain or swelling, muscle weakness, poor recovery after exercise)" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Difficulties with memory" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Problems with thinking, concentrating or reasoning" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Difficulty learning new things" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Trouble thinking of the right word to describe persons, places or things when speaking" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Increase in frequency or intensity of headaches/migraines" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Rapid hair loss or thinning" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Feel cold all the time or have cold hands or feet" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Weight gain, increased belly fat, or difficulty losing weight despite diet and exercise" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Infrequent or absent ejaculations" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
"Difficulties with memory" => ["radio" => ['none', 'mild', 'moderate', 'severe', 'very severe']],
]
];