487 lines
10 KiB
JavaScript
487 lines
10 KiB
JavaScript
export default {
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"steps": {
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"page0": {
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"elements": [
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"h3",
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"h4",
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"injury_type"
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],
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"buttons": {
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"previous": false
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}
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},
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"page1": {
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"elements": [
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"h2_1",
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"h4_1",
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"injury_time",
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"pain_level"
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]
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},
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"page2": {
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"elements": [
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"h2",
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"h4_2",
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"chronic_conditions",
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"chronic_conditions_reason"
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]
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},
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"page3": {
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"elements": [
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"h4_3",
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"serious_injuries",
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"serious_injuries_description"
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]
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},
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"page4": {
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"elements": [
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"h2_2",
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"h4_4",
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"current_medications"
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]
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},
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"page5": {
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"elements": [
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"h4_5",
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"swelling",
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"swelling_description"
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]
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},
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"page6": {
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"elements": [
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"h2_3",
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"h4_6",
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"mobility_issues"
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]
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},
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"page7": {
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"elements": [
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"h4_7",
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"rehabilitation_services",
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"rehabilitation_services_description"
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]
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},
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"page8": {
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"elements": [
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"h2_4",
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"h4_8",
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"previous_peptide_therapies",
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"previous_peptide_therapies_description"
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]
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},
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"page9": {
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"elements": [
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"h4_9",
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"peptide_sensitivities"
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]
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},
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"page10": {
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"elements": [
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"h4_10",
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"pregnant"
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]
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}
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},
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"schema": {
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"h3": {
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"type": "static",
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"tag": "h2",
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"content": "Injury Repair",
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"align": "left"
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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": "What type of injury are you seeking treatment for?"
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},
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"injury_type": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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"items": [
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{
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"value": "muscle strain",
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"label": "Muscle Strain"
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},
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{
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"value": "joint injury",
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"label": "Joint Injury"
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},
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{
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"value": "ligament tear",
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"label": "Ligament Tear"
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},
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{
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"value": "other",
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"label": "Other"
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}
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]
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},
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"h2_1": {
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"type": "static",
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"tag": "h2",
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"content": "Injury Details"
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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": "How long ago did the injury occur?"
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},
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"injury_time": {
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"type": "text",
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"inputType": "text",
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"rules": [
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"required"
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]
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},
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"pain_level": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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"items": [
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{
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"value": "1",
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"label": "1 (Mild)"
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},
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{
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"value": "2",
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"label": "2"
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},
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{
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"value": "3",
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"label": "3"
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},
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{
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"value": "4",
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"label": "4"
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},
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{
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"value": "5",
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"label": "5"
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},
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{
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"value": "6",
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"label": "6"
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},
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{
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"value": "7",
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"label": "7"
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},
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{
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"value": "8",
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"label": "8"
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},
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{
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"value": "9",
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"label": "9"
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},
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{
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"value": "10",
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"label": "10 (Severe)"
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}
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]
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},
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"h2": {
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"type": "static",
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"tag": "h2",
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"content": "Medical History"
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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 been diagnosed with any chronic medical conditions (e.g., diabetes, heart disease)?"
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},
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"chronic_conditions": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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"chronic_conditions_reason": {
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"type": "text",
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"label": "If yes, please specify the condition.",
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"rules": [
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"required"
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],
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"conditions": [
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[
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"chronic_conditions",
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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_3": {
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"type": "static",
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"tag": "h4",
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"content": "Do you have a history of any serious injuries or surgeries?"
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},
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"serious_injuries": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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"serious_injuries_description": {
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"type": "text",
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"label": "If yes, please describe.",
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"rules": [
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"required"
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],
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"conditions": [
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[
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"serious_injuries",
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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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"h2_2": {
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"type": "static",
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"tag": "h2",
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"content": "Current Medications"
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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": "Are you currently taking any medications or supplements?"
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},
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"current_medications": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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"h4_5": {
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"type": "static",
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"tag": "h4",
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"content": "Are you experiencing any swelling, bruising, or redness in the affected area?"
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},
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"swelling": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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"swelling_description": {
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"type": "text",
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"label": "If yes, please describe.",
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"rules": [
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"required"
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],
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"conditions": [
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[
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"swelling",
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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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"h2_3": {
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"type": "static",
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"tag": "h2",
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"content": "Mobility Issues"
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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": "Are you having any issues with mobility or range of motion in the affected area?"
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},
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"mobility_issues": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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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 undergone any physical therapy, chiropractic care, or other rehabilitation services for this injury?"
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},
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"rehabilitation_services": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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"rehabilitation_services_description": {
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"type": "text",
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"label": "If yes, please describe.",
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"rules": [
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"required"
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],
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"conditions": [
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[
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"rehabilitation_services",
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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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"h2_4": {
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"type": "static",
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"tag": "h2",
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"content": "Previous Treatments"
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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": "Have you used any other peptide therapies or similar treatments in the past?"
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},
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"previous_peptide_therapies": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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"previous_peptide_therapies_description": {
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"type": "text",
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"label": "If yes, please describe the results.",
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"rules": [
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"required"
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],
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"conditions": [
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[
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"previous_peptide_therapies",
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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_9": {
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"type": "static",
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"tag": "h4",
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"content": "Do you have any known sensitivities to peptide-based therapies?"
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},
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"peptide_sensitivities": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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},
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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 Pregnant? (Female Specific)"
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},
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"pregnant": {
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"type": "radiogroup",
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"rules": [
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"required"
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],
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"view": "blocks",
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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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}
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}
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} |