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

725 lines
19 KiB
JavaScript

export default{
steps: {
page0: {
elements: [
'h3',
'dizziness_or_fainting',
],
},
page1: {
elements: [
'h3_1',
'falls_that_caused_an_injury',
],
},
page2: {
elements: [
'h3_2',
'stroke',
],
},
page3: {
elements: [
'h3_3',
'shortness_of_breath_when_walking_1_to_2_blocks',
],
},
page4: {
elements: [
'h3_4',
'shortness_of_breath_when_climbing_1_flight_of_stairs',
],
},
page5: {
elements: [
'h3_5',
'shortness_of_breath_when_lying_down',
],
},
page6: {
elements: [
'h3_6',
'lower_leg_cramps_while_walking',
],
},
page7: {
elements: [
'h3_7',
'bleeding_problems_or_low_iron_also _called_anemia',
],
},
page8: {
elements: [
'h3_8',
'blood_clot_in_leg_also_called_phlebitis',
],
},
page9: {
elements: [
'h3_9',
'high_cholesterol',
],
},
page10: {
elements: [
'h3_10',
'diabetes',
],
},
page11: {
elements: [
'h3_11',
'high_blood_pressure',
],
},
page12: {
elements: [
'h3_12',
'heart_murmur_or_abnormal_heart_valve',
],
},
page13: {
elements: [
'h3_13',
'uncomfortable_feeling_in_the_chest',
],
},
page14: {
elements: [
'h3_14',
'chest_pain_with_activity_also_called_angina',
],
},
page15: {
elements: [
'h3_15',
'heart_attack_also_called_myocardial_infarction',
],
},
page16: {
elements: [
'h3_16',
'swollen_legs',
],
},
page17: {
elements: [
'h3_17',
'ankles_or_feet',
],
},
page18: {
elements: [
'h3_18',
'Irregular_heartbeat',
],
},
page19: {
elements: [
'h3_19',
'stress_test_or_treadmill_test',
],
},
page20: {
elements: [
'h3_20',
'cardiac_catheterization_or_angiogram',
],
},
page21: {
elements: [
'h3_21',
'angioplasty_or_stent',
],
},
page22: {
elements: [
'h3_22',
'heart_surgery_If_so_what_kind',
'hurt_surgery_kind_please_explain',
],
},
page23: {
elements: [
'h3_23',
'special_meal_plan_or_diet',
'which_special_meal_plan_or_diet',
],
},
page24: {
elements: [
'h3_24',
'do_you_exercise_regularly',
'exercisy_regularly_how many_days_a_week',
],
},
},
schema: {
h3: {
type: 'static',
tag: 'h3',
content: 'Dizziness or fainting',
},
dizziness_or_fainting: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_1: {
type: 'static',
tag: 'h3',
content: 'Falls that caused an injury',
},
falls_that_caused_an_injury: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_2: {
type: 'static',
tag: 'h3',
content: 'Stroke',
},
stroke: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_3: {
type: 'static',
tag: 'h3',
content: 'Shortness of breath when walking 1 to 2 blocks',
},
shortness_of_breath_when_walking_1_to_2_blocks: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_4: {
type: 'static',
tag: 'h3',
content: 'Shortness of breath when climbing 1 flight of stairs',
},
shortness_of_breath_when_climbing_1_flight_of_stairs: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_5: {
type: 'static',
tag: 'h3',
content: 'Shortness of breath when lying down',
},
shortness_of_breath_when_lying_down: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_6: {
type: 'static',
tag: 'h3',
content: 'Lower leg cramps while walking',
},
lower_leg_cramps_while_walking: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_7: {
type: 'static',
tag: 'h3',
content: 'Bleeding problems or low iron (also called anemia)',
},
'bleeding_problems_or_low_iron_also _called_anemia': {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_8: {
type: 'static',
tag: 'h3',
content: 'Blood clot in leg (also called phlebitis)',
},
blood_clot_in_leg_also_called_phlebitis: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_9: {
type: 'static',
tag: 'h3',
content: 'High cholesterol',
},
high_cholesterol: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_10: {
type: 'static',
tag: 'h3',
content: 'Diabetes',
},
diabetes: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_11: {
type: 'static',
tag: 'h3',
content: 'High blood pressure',
},
high_blood_pressure: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_12: {
type: 'static',
tag: 'h3',
content: 'Heart murmur or abnormal heart valve',
},
heart_murmur_or_abnormal_heart_valve: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_13: {
type: 'static',
tag: 'h3',
content: 'Uncomfortable feeling in the chest',
},
uncomfortable_feeling_in_the_chest: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_14: {
type: 'static',
tag: 'h3',
content: 'Chest pain with activity (also called angina)',
},
chest_pain_with_activity_also_called_angina: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_15: {
type: 'static',
tag: 'h3',
content: 'Heart attack (also called myocardial infarction)',
},
heart_attack_also_called_myocardial_infarction: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_16: {
type: 'static',
tag: 'h3',
content: 'Swollen legs',
},
swollen_legs: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_17: {
type: 'static',
tag: 'h3',
content: 'ankles or feet',
},
ankles_or_feet: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
rules: [
'required',
],
},
h3_18: {
type: 'static',
tag: 'h3',
content: 'Irregular heartbeat',
},
Irregular_heartbeat: {
type: 'radiogroup',
items: [
{
value: 'Within last 30 days',
label: 'Within last 30 days',
},
{
value: 'In the past',
label: 'In the past',
},
],
},
h3_19: {
type: 'static',
tag: 'h3',
content: 'Have you had any of the following tests or procedures?',
},
stress_test_or_treadmill_test: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
label: 'Stress test or treadmill test:',
rules: [
'required',
],
},
h3_20: {
type: 'static',
tag: 'h3',
content: 'Have you had any of the following tests or procedures',
},
cardiac_catheterization_or_angiogram: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
label: 'Cardiac catheterization or angiogram:',
rules: [
'required',
],
},
h3_21: {
type: 'static',
tag: 'h3',
content: 'Have you had any of the following tests or procedures?',
},
angioplasty_or_stent: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
label: 'Angioplasty or stent',
rules: [
'required',
],
},
h3_22: {
type: 'static',
tag: 'h3',
content: 'Have you had any of the following tests or procedures?',
},
heart_surgery_If_so_what_kind: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
label: 'Heart surgery If so, what kind?',
rules: [
'required',
],
},
hurt_surgery_kind_please_explain: {
type: 'textarea',
label: 'Please explain',
conditions: [
[
'heart_surgery_If_so_what_kind',
'in',
[
'yes',
],
],
],
},
h3_23: {
type: 'static',
tag: 'h3',
content: 'Do you follow a special meal plan or diet (such as Atkins®, Weight Watchers®, vegetarian, low fat, or diabetic)?',
},
special_meal_plan_or_diet: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
which_special_meal_plan_or_diet: {
type: 'text',
label: 'Which meal plan or diet you follow?',
conditions: [
[
'special_meal_plan_or_diet',
'in',
[
'yes',
],
],
],
},
h3_24: {
type: 'static',
tag: 'h3',
content: 'Do you exercise regularly?',
},
do_you_exercise_regularly: {
type: 'radiogroup',
items: [
{
value: 'yes',
label: 'Yes',
},
{
value: 'no',
label: 'No',
},
],
rules: [
'required',
],
},
'exercisy_regularly_how many_days_a_week': {
type: 'text',
label: 'How many days a week?',
conditions: [
[
'do_you_exercise_regularly',
'in',
[
'yes',
],
],
],
},
},
}