rejuvallife/resources/js/views/pages/questionere/neurology-form.js
2024-10-25 01:02:11 +05:00

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export default{
steps: {
page0: {
elements: [
'neurology_atrial_fibrillation',
'atrial_fibrillation',
],
},
page1: {
elements: [
'neurology_bowel_problems',
'bowel_problems',
],
},
page2: {
elements: [
'neurology_crohns_disease',
'crohns_disease',
],
},
page3: {
elements: [
'neurology_loss_of_consciousness',
'loss_of_consciousness',
],
},
page4: {
elements: [
'neurology_parkinsons_disease',
'parkinsons_disease',
],
},
page5: {
elements: [
'neurology_fibromyalgia',
'fibromyalgia',
],
},
page6: {
elements: [
'neurology_stomach_ulcers',
'stomach_ulcers',
],
},
page7: {
elements: [
'neurology_neck_surgery',
'neck_surgery',
],
},
page8: {
elements: [
'neurology_back_surgery',
'back_surgery',
],
},
page9: {
elements: [
'neurology_aneurysm_surgery',
'aneurysm_surgery',
],
},
page10: {
elements: [
'neurology_abdominal_surgery',
'Abdominal_Surgery',
],
},
page11: {
elements: [
'neurology_bowel_surgery',
'Bowel_Surgery',
],
},
page12: {
elements: [
'neurology_Bypass_in_the_legs',
'Bypass_in_the_legs',
],
},
page13: {
elements: [
'neurology_gallbladder_surgery',
'gallbladder_surgery',
],
},
page14: {
elements: [
'neurology_gastric_bypass_surgery',
'gastric_bypass_surgery',
],
},
page15: {
elements: [
'neurology_gynecologic_surgery',
'gynecologic_surgery',
],
},
page16: {
elements: [
'neurology_implants_type',
'implants_type',
],
},
page17: {
elements: [
'neurology_intrathecal_pump',
'intrathecal_pump',
],
},
page18: {
elements: [
'neurology_pacemaker_surgery',
'pacemaker_surgery',
],
},
page19: {
elements: [
'neurology_stimulator',
'stimulator',
],
},
page20: {
elements: [
'neurology_use_caffeine',
'use_caffeine',
],
},
page21: {
elements: [
'neurology_street_drug',
'street_drug',
],
},
page22: {
elements: [
'neurology_dementia',
'dementia',
],
},
page23: {
elements: [
'neurology_epilepsy',
'epilepsy',
],
},
page24: {
elements: [
'neurology_migraine_headaches',
'migraine_headaches',
],
},
page25: {
elements: [
'neurology_polyneuropathy',
'polyneuropathy',
],
},
page26: {
elements: [
'neurology_tremor',
'tremor',
],
},
page27: {
elements: [
'neurology_poor_memory',
'poor_memory',
],
},
page28: {
elements: [
'neurology_difficulty_finding_words',
'difficulty_finding_words',
],
},
page29: {
elements: [
'neurology_frequent_sore_throat',
'frequent_sore_throat',
],
},
page30: {
elements: [
'neurology_hoarseness',
'hoarseness',
],
},
page31: {
elements: [
'neurology_discharge_from_nose',
'discharge_from_nose',
],
},
page32: {
elements: [
'neurology_repeated_sinus_infections',
'repeated_sinus_infections',
],
},
page33: {
elements: [
'neurology_palpitations',
'palpitations',
],
},
page34: {
elements: [
'neurology_irregular_heart_beat',
'irregular_heart_beat',
],
},
page35: {
elements: [
'neurology_cold_hands',
'cold_hands',
],
},
page36: {
elements: [
'neurology_cold_feet',
'cold_feet',
],
},
page37: {
elements: [
'neurology_chronic_cough',
'chronic_cough',
],
},
page38: {
elements: [
'neurology_muscle_loss',
'muscle_loss',
],
},
page39: {
elements: [
'neurology_excessive_thirst',
'excessive_thirst',
],
},
page40: {
elements: [
'neurology_farsighted',
'farsighted',
],
},
page41: {
elements: [
'neurology_nearsighted',
'nearsighted',
],
},
page42: {
elements: [
'neurology_changes_in_hair',
'changes_in_hair',
],
},
page43: {
elements: [
'neurology_changes_in_nails',
'changes_in_nails',
],
},
page44: {
elements: [
'neurology_changes_in_skin_color',
'changes_in_skin_color',
],
},
page45: {
elements: [
'neurology_dry_skin',
'dry_skin',
],
},
},
schema: {
neurology_atrial_fibrillation: {
type: 'static',
tag: 'h3',
content: ' Atrial fibrillation',
},
atrial_fibrillation: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
},
neurology_bowel_problems: {
type: 'static',
tag: 'h3',
content: 'Bowel Problems',
},
bowel_problems: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_crohns_disease: {
type: 'static',
tag: 'h3',
content: 'Crohns Disease',
},
crohns_disease: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_loss_of_consciousness: {
type: 'static',
tag: 'h3',
content: 'Loss of consciousness',
},
loss_of_consciousness: {
type: 'text',
placeholder: 'Loss of consciousness',
rules: [
'required',
],
},
'neurology_parkinsons_disease': {
type: 'static',
tag: 'h3',
content: 'Parkinsons Disease',
},
parkinsons_disease: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_fibromyalgia: {
type: 'static',
tag: 'h3',
content: 'Fibromyalgia',
},
fibromyalgia: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_stomach_ulcers: {
type: 'static',
tag: 'h3',
content: 'Stomach Ulcers',
},
stomach_ulcers: {
type: 'text',
placeholder: 'Stomach Ulcers',
},
neurology_neck_surgery: {
type: 'static',
tag: 'h3',
content: 'Neck Surgery',
},
neck_surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_back_surgery: {
type: 'static',
tag: 'h3',
content: 'Back Surgery',
},
back_surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_aneurysm_surgery: {
type: 'static',
tag: 'h3',
content: 'Aneurysm Surgery',
},
aneurysm_surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_abdominal_surgery: {
type: 'static',
tag: 'h3',
content: 'Abdominal Surgery',
},
Abdominal_Surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_bowel_surgery: {
type: 'static',
tag: 'h3',
content: 'Bowel Surgery',
},
Bowel_Surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_Bypass_in_the_legs: {
type: 'static',
tag: 'h3',
content: 'Bypass in the legs',
},
Bypass_in_the_legs: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_gallbladder_surgery: {
type: 'static',
tag: 'h3',
content: 'Gallbladder Surgery',
},
gallbladder_surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_gastric_bypass_surgery: {
type: 'static',
tag: 'h3',
content: 'Gastric bypass surgery',
},
gastric_bypass_surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_gynecologic_surgery: {
type: 'static',
tag: 'h3',
content: 'Gynecologic surgery',
},
gynecologic_surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_implants_type: {
type: 'static',
tag: 'h3',
content: 'Implants Type',
},
implants_type: {
type: 'text',
rules: [
'required',
],
},
neurology_intrathecal_pump: {
type: 'static',
tag: 'h3',
content: 'Intrathecal Pump',
},
intrathecal_pump: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_pacemaker_surgery: {
type: 'static',
tag: 'h3',
content: 'Pacemaker Surgery',
},
pacemaker_surgery: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_stimulator: {
type: 'static',
tag: 'h3',
content: 'Stimulator',
},
stimulator: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_use_caffeine: {
type: 'static',
tag: 'h3',
content: 'Use caffeine',
},
use_caffeine: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_street_drug: {
type: 'static',
tag: 'h3',
content: 'Street Drug',
},
street_drug: {
type: 'text',
},
neurology_dementia: {
type: 'static',
tag: 'h3',
content: 'Dementia',
},
dementia: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_epilepsy: {
type: 'static',
tag: 'h3',
content: 'Epilepsy',
},
epilepsy: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_migraine_headaches: {
type: 'static',
tag: 'h3',
content: 'Migraine Headaches',
},
migraine_headaches: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_polyneuropathy: {
type: 'static',
tag: 'h3',
content: 'Polyneuropathy',
},
polyneuropathy: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_tremor: {
type: 'static',
tag: 'h3',
content: 'Tremor',
},
tremor: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_poor_memory: {
type: 'static',
tag: 'h3',
content: 'Poor memory',
},
poor_memory: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_difficulty_finding_words: {
type: 'static',
tag: 'h3',
content: 'Difficulty finding words',
},
difficulty_finding_words: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_frequent_sore_throat: {
type: 'static',
tag: 'h3',
content: 'Frequent sore throat',
},
frequent_sore_throat: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_hoarseness: {
type: 'static',
tag: 'h3',
content: 'Hoarseness',
},
hoarseness: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_discharge_from_nose: {
type: 'static',
tag: 'h3',
content: 'Discharge from nose',
},
discharge_from_nose: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_repeated_sinus_infections: {
type: 'static',
tag: 'h3',
content: 'Repeated sinus infections',
},
repeated_sinus_infections: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_palpitations: {
type: 'static',
tag: 'h3',
content: 'Palpitations',
},
palpitations: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_irregular_heart_beat: {
type: 'static',
tag: 'h3',
content: 'Irregular heart beat',
},
irregular_heart_beat: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_cold_hands: {
type: 'static',
tag: 'h3',
content: 'Cold hands',
},
cold_hands: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_cold_feet: {
type: 'static',
tag: 'h3',
content: 'Cold feet',
},
cold_feet: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_chronic_cough: {
type: 'static',
tag: 'h3',
content: 'Chronic cough',
},
chronic_cough: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_muscle_loss: {
type: 'static',
tag: 'h3',
content: 'Muscle loss',
},
muscle_loss: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_excessive_thirst: {
type: 'static',
tag: 'h3',
content: 'Excessive thirst',
},
excessive_thirst: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_farsighted: {
type: 'static',
tag: 'h3',
content: 'Farsighted',
},
farsighted: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_nearsighted: {
type: 'static',
tag: 'h3',
content: 'Nearsighted',
},
nearsighted: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_changes_in_hair: {
type: 'static',
tag: 'h3',
content: 'Changes in hair',
},
changes_in_hair: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_changes_in_nails: {
type: 'static',
tag: 'h3',
content: 'Changes in nails',
},
changes_in_nails: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_changes_in_skin_color: {
type: 'static',
tag: 'h3',
content: 'Changes in skin color',
},
changes_in_skin_color: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
neurology_dry_skin: {
type: 'static',
tag: 'h3',
content: 'Dry skin',
},
dry_skin: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
},
}