669 lines
16 KiB
JavaScript
669 lines
16 KiB
JavaScript
export default {
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steps: {
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page0: {
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elements: [
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'h4_5',
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'p',
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'm_g_weight_lb',
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'm_g_height_feet',
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'm_g_height_inches',
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],
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},
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page1: {
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elements: [
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'h4',
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'm_g_expecting',
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],
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},
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page2: {
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label: '',
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elements: [
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'h4_1',
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'm_g_cond_symptoms_tb_500',
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],
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},
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page3: {
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label: '',
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elements: [
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'h4_2',
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'm_g_peptide_tehrapies',
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],
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},
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page4: {
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label: '',
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elements: [
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'h4_3',
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'm_g_injury_cond',
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'caloric_intake',
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],
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},
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page5: {
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label: '',
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elements: [
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'h4_4',
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'm_g_long_exp_issue',
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],
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},
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page6: {
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label: '',
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elements: [
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'h4_6',
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'm_g_severity_symptoms',
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],
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},
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page7: {
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label: '',
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elements: [
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'h4_7',
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'm_g_medical_treatments',
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'm_g_treatments_describe',
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],
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},
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page8: {
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label: '',
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elements: [
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'h4_8',
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'm_g_chronic_health_cond',
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],
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},
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page9: {
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label: '',
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elements: [
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'h4_9',
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'm_g_known_allergies',
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'm_g_known_allergies_describe',
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],
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},
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page10: {
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label: '',
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elements: [
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'h4_10',
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'm_g_other_medications',
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'm_g_other_medications_describe',
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'smoke_alcohol',
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],
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},
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page11: {
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label: '',
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elements: [
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'h4_11',
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'm_g_physical_activity',
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],
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},
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page12: {
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label: '',
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elements: [
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'h4_12',
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'm_g_typical_diet',
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],
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},
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page13: {
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label: '',
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elements: [
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'h4_13',
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'm_g_sleep_quality',
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],
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},
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page14: {
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label: '',
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elements: [
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'h4_14',
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'm_g_in_person_med_evealuation',
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],
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},
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page15: {
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label: '',
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elements: [
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'h4_15',
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'm_g_tests_completed',
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],
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},
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page16: {
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label: '',
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elements: [
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'h4_16',
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'm_g_gastrointestinal_or_metabolic_conditions',
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'm_g_gastrointestinal_or_metabolic_conditions_describe',
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],
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},
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page17: {
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label: '',
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elements: [
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'h4_17',
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'm_g_thyroid_issues_or_diabetes',
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'm_g_thyroid_issues_or_diabetes_describe',
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],
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},
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page18: {
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label: '',
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elements: [
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'h3',
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'm_g_systolic_diastolic',
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],
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},
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page19: {
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label: '',
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elements: [
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'h3_1',
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'm_g_tb_500_therapy',
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],
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},
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},
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schema: {
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h4_5: {
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type: 'static',
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tag: 'h4',
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content: 'We require that you provide a recent blood pressure measurement within the last six months.',
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},
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p: {
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type: 'static',
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tag: 'p',
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content: 'Blood pressure should be listed as follows: Systolic (top number) / Diastolic (bottom number).\nIf you are not sure, please go have your blood pressure obtained (often free at your local pharmacy).\n',
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},
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m_g_weight_lb: {
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type: 'text',
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label: 'Weight (lb) (Optional)',
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},
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m_g_height_feet: {
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type: 'text',
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label: 'Height (feet) (Optional)',
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fieldName: ' ',
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columns: {
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container: 6,
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},
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},
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m_g_height_inches: {
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type: 'text',
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label: 'Height (inches) (Optional)',
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fieldName: ' ',
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columns: {
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container: 6,
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},
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},
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h4: {
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type: 'static',
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tag: 'h4',
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content: 'Are you pregnant or expecting to be?',
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},
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m_g_expecting: {
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type: 'radiogroup',
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items: [
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{
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value: 'pregnant',
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label: 'Pregnant',
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},
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{
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value: 'breastfeeding ',
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label: 'Breastfeeding or lactating',
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},
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{
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value: 'expecting_pregnant',
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label: 'Expecting to be pregnant',
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},
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{
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value: 'not_applicable',
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label: 'No or Not Applicable',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_1: {
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type: 'static',
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tag: 'h4',
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content: 'What specific conditions or symptoms are you seeking treatment for with TB-500?',
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},
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m_g_cond_symptoms_tb_500: {
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type: 'checkboxgroup',
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items: [
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{
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value: 'muscle_injuries',
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label: 'Muscle injuries',
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},
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{
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value: 'joint_pain',
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label: 'Joint pain',
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},
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{
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value: 'tendonitis',
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label: 'Tendonitis',
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},
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{
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value: 'wound_healing',
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label: 'Wound healing',
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},
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{
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value: 'inflammation',
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label: 'Inflammation',
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},
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],
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rules: [
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'required',
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],
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fieldName: ' ',
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},
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h4_2: {
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type: 'static',
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tag: 'h4',
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content: 'Have you previously used TB-500 or any other hgh therapies',
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},
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m_g_peptide_tehrapies: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_3: {
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type: 'static',
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tag: 'h4',
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content: 'Describe the nature of your injury or condition:',
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},
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m_g_injury_cond: {
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type: 'text',
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rules: [
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'validateTextBox',
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],
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fieldName: ' ',
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},
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h4_4: {
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type: 'static',
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tag: 'h4',
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content: 'How long have you been experiencing this issue?',
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},
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m_g_long_exp_issue: {
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type: 'text',
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rules: [
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'validateTextBox',
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],
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fieldName: ' ',
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},
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h4_6: {
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type: 'static',
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tag: 'h4',
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content: 'Can you rate the severity of your symptoms on a scale from 1 to 10?',
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},
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m_g_severity_symptoms: {
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type: 'text',
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rules: [
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'validateTextBox',
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],
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fieldName: ' ',
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},
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h4_7: {
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type: 'static',
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tag: 'h4',
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content: 'Have you had any recent surgeries or medical treatments for this condition?\n',
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},
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m_g_medical_treatments: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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m_g_treatments_describe: {
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type: 'textarea',
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label: 'Please Describe',
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rules: [
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'validateTextArea',
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],
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fieldName: ' ',
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conditions: [
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[
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'm_g_medical_treatments',
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'in',
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[
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'yes',
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],
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],
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],
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},
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h4_8: {
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type: 'static',
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tag: 'h4',
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content: 'Do you have any chronic health conditions?',
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},
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m_g_chronic_health_cond: {
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type: 'checkboxgroup',
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items: [
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{
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value: 'high_blood_pressure',
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label: 'High blood pressure',
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},
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{
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value: 'diabetes',
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label: 'Diabetes',
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},
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{
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value: 'cardiovascular_disease',
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label: 'Cardiovascular disease',
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},
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{
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value: 'chronic_renal_failure',
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label: 'Chronic renal failure',
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},
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{
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value: 'none_of_the_above',
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label: 'None of the above',
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},
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],
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rules: [
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'required',
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],
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fieldName: ' ',
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},
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h4_9: {
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type: 'static',
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tag: 'h4',
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content: 'Do you have any known allergies, particularly to medications or hgh?',
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},
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m_g_known_allergies: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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m_g_known_allergies_describe: {
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type: 'textarea',
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label: 'Please Describe',
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rules: [
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'validateTextArea',
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],
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fieldName: ' ',
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conditions: [
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[
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'm_g_known_allergies',
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'in',
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[
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'yes',
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],
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],
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],
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},
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h4_10: {
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type: 'static',
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tag: 'h4',
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content: 'Are you currently taking any other medications or supplements?',
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},
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m_g_other_medications: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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m_g_other_medications_describe: {
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type: 'textarea',
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label: 'Please Describe',
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rules: [
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'validateTextArea',
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],
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|
fieldName: ' ',
|
|
conditions: [
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[
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'm_g_other_medications',
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'in',
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[
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'yes',
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],
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],
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],
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},
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smoke_alcohol: {
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type: 'radiogroup',
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},
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h4_11: {
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type: 'static',
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tag: 'h4',
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content: 'What is your current level of physical activity?',
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},
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m_g_physical_activity: {
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type: 'checkboxgroup',
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items: [
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{
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value: 'sedentary',
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label: 'Sedentary',
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|
},
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|
{
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|
value: 'light_exercise',
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label: 'Light exercise (1-2 days per week)',
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},
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{
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value: 'moderate_exercise',
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label: 'Moderate exercise (3-4 days per week)',
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},
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{
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value: 'intense_exercise',
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label: 'Intense exercise (5-7 days per week)',
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},
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],
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rules: [
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'required',
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],
|
|
fieldName: ' ',
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},
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h4_12: {
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type: 'static',
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tag: 'h4',
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content: 'Describe your typical diet and any dietary restrictions:',
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},
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m_g_typical_diet: {
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type: 'textarea',
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rules: [
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'validateTextArea',
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],
|
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fieldName: ' ',
|
|
},
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h4_13: {
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|
type: 'static',
|
|
tag: 'h4',
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content: 'How would you describe your sleep quality and patterns?',
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},
|
|
m_g_sleep_quality: {
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type: 'textarea',
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|
rules: [
|
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'validateTextArea',
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|
],
|
|
fieldName: ' ',
|
|
},
|
|
h4_14: {
|
|
type: 'static',
|
|
tag: 'h4',
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content: 'When was the last time you had an in-person medical evaluation?',
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},
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|
m_g_in_person_med_evealuation: {
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|
type: 'checkboxgroup',
|
|
items: [
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|
{
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|
value: 'less_than_a_year_ago',
|
|
label: 'Less than a year ago',
|
|
},
|
|
{
|
|
value: '1_to_2_years_ago',
|
|
label: '1 to 2 years ago',
|
|
},
|
|
{
|
|
value: 'more_than_2_years_ago',
|
|
label: 'More than 2 years ago',
|
|
},
|
|
],
|
|
rules: [
|
|
'required',
|
|
],
|
|
fieldName: ' ',
|
|
},
|
|
h4_15: {
|
|
type: 'static',
|
|
tag: 'h4',
|
|
content: 'Have you had any lab tests completed within the last 12 months that you would like to share with your doctor?',
|
|
},
|
|
m_g_tests_completed: {
|
|
type: 'radiogroup',
|
|
items: [
|
|
{
|
|
value: 'yes',
|
|
label: 'Yes',
|
|
},
|
|
{
|
|
value: 'no',
|
|
label: 'No, not at this time',
|
|
},
|
|
],
|
|
rules: [
|
|
'validateRadio',
|
|
],
|
|
fieldName: ' ',
|
|
},
|
|
h4_16: {
|
|
type: 'static',
|
|
tag: 'h4',
|
|
content: 'Does anyone in your family have a history of gastrointestinal or metabolic conditions?',
|
|
},
|
|
m_g_gastrointestinal_or_metabolic_conditions: {
|
|
type: 'radiogroup',
|
|
items: [
|
|
{
|
|
value: 'yes',
|
|
label: 'Yes',
|
|
},
|
|
{
|
|
value: 'no',
|
|
label: 'No',
|
|
},
|
|
],
|
|
rules: [
|
|
'validateRadio',
|
|
],
|
|
fieldName: ' ',
|
|
},
|
|
m_g_gastrointestinal_or_metabolic_conditions_describe: {
|
|
type: 'textarea',
|
|
label: 'Please Describe',
|
|
rules: [
|
|
'validateTextArea',
|
|
],
|
|
fieldName: ' ',
|
|
conditions: [
|
|
[
|
|
'm_g_gastrointestinal_or_metabolic_conditions',
|
|
'in',
|
|
[
|
|
'yes',
|
|
],
|
|
],
|
|
],
|
|
},
|
|
h4_17: {
|
|
type: 'static',
|
|
tag: 'h4',
|
|
content: 'Does anyone in your family have a history of thyroid issues or diabetes?',
|
|
},
|
|
m_g_thyroid_issues_or_diabetes: {
|
|
type: 'radiogroup',
|
|
items: [
|
|
{
|
|
value: 'yes',
|
|
label: 'Yes',
|
|
},
|
|
{
|
|
value: 'no',
|
|
label: 'No',
|
|
},
|
|
],
|
|
rules: [
|
|
'validateRadio',
|
|
],
|
|
fieldName: ' ',
|
|
},
|
|
m_g_thyroid_issues_or_diabetes_describe: {
|
|
type: 'textarea',
|
|
rules: [
|
|
'validateTextArea',
|
|
],
|
|
fieldName: ' ',
|
|
conditions: [
|
|
[
|
|
'm_g_thyroid_issues_or_diabetes',
|
|
'in',
|
|
[
|
|
'yes',
|
|
],
|
|
],
|
|
],
|
|
},
|
|
h3: {
|
|
type: 'static',
|
|
tag: 'h3',
|
|
content: 'We require that you provide a recent blood pressure measurement within the last six months. Blood pressure should be listed as follows: Systolic (top number) / Diastolic (bottom number). If you are not sure, please go have your blood pressure obtained (often free at your local pharmacy).',
|
|
},
|
|
m_g_systolic_diastolic: {
|
|
type: 'text',
|
|
label: 'Blood Pressure (Systolic/Diastolic):',
|
|
rules: [
|
|
'validateTextBox',
|
|
],
|
|
fieldName: ' ',
|
|
},
|
|
h3_1: {
|
|
type: 'static',
|
|
tag: 'h3',
|
|
content: 'Is there any other relevant information or concerns you would like to discuss with your doctor regarding TB-500 therapy?',
|
|
},
|
|
m_g_tb_500_therapy: {
|
|
type: 'text',
|
|
rules: [
|
|
'validateTextBox',
|
|
],
|
|
fieldName: ' ',
|
|
},
|
|
},
|
|
}
|