1997 lines
35 KiB
JavaScript
1997 lines
35 KiB
JavaScript
// import { useStore } from 'vuex';
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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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"low_libido"
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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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"h3_1",
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"depression"
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]
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},
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"page2": {
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"elements": [
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"h3_2",
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"decreased_muscle_mass"
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]
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},
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"page3": {
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"elements": [
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"h3_3",
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"sleep_disturbances"
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]
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},
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"page4": {
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"elements": [
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"h3_4",
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"fatigue"
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]
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},
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"page5": {
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"elements": [
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"h3_5",
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"bone_loss"
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]
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},
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"page6": {
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"elements": [
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"h3_6",
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"memory_lapses"
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]
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},
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"page7": {
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"elements": [
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"h3_7",
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"thinning_skin"
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]
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},
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"page8": {
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"elements": [
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"h3_8",
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"incontinence"
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]
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},
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"page9": {
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"elements": [
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"h3_9",
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"fibromyalgia"
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]
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},
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"page10": {
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"elements": [
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"h3_10",
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"heart_palpitations"
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]
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},
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"page11": {
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"elements": [
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"h3_11",
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"excessive_facial_hair"
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]
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},
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"page12": {
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"elements": [
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"h3_12",
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"oily_skin"
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]
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},
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"page13": {
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"elements": [
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"h3_13",
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"excessive_body_hair"
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]
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},
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"page14": {
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"elements": [
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"h3_14",
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"hair_loss_on_scalp"
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]
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},
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"page15": {
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"elements": [
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"h3_15",
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"increased_acne"
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]
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},
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"page16": {
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"elements": [
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"h3_16",
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"irritability"
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]
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},
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"page17": {
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"elements": [
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"h3_17",
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"breast_cancer"
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]
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},
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"page18": {
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"elements": [
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"h3_18",
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"elevated_triglycerides"
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]
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},
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"page19": {
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"elements": [
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"h3_19",
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"chemical_sensitivity"
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]
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},
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"page20": {
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"elements": [
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"h3_20",
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"cold_body_temperature"
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]
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},
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"page21": {
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"elements": [
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"h3_21",
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"sugar_cravings"
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]
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},
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"page22": {
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"elements": [
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"h3_22",
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"moody"
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]
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},
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"page23": {
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"elements": [
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"h3_23",
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"allergies"
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]
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},
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"page24": {
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"elements": [
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"h3_24",
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"arthritis"
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]
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},
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"page25": {
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"elements": [
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"h3_25",
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"stress"
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]
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},
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"page26": {
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"elements": [
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"h3_26",
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"aches_and_pains"
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]
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},
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"page27": {
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"elements": [
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"h3_27",
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"headaches"
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]
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},
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"page28": {
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"elements": [
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"h3_28",
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"perspiration"
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]
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},
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"page29": {
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"elements": [
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"h3_29",
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"anxiety"
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]
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},
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"page30": {
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"elements": [
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"h3_30",
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"tired_or_exhausted"
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]
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},
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"page31": {
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"elements": [
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"h3_31",
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"nails_brittle_or_breaking"
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]
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},
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"page32": {
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"elements": [
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"h3_32",
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"cold_hands_and_feet"
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]
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},
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"page33": {
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"elements": [
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"h3_33",
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"dry_and_brittle_hair"
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]
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},
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"page34": {
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"elements": [
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"h3_34",
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"dry_skin_and_hair"
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]
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},
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"page35": {
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"elements": [
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"h3_35",
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"hoarseness"
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]
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},
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"page36": {
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"elements": [
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"h3_36",
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"slowed_reflexes"
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]
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},
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"page37": {
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"elements": [
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"h3_37",
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"infertility_problems"
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]
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},
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"page38": {
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"elements": [
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"h3_38",
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"constipation"
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]
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},
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"page39": {
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"elements": [
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"h3_39",
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"decreased_sweating"
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]
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},
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"page40": {
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"elements": [
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"h3_40",
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"mood_changes"
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]
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},
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"page41": {
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"elements": [
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"h3_41",
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"swelling_puffy_eyes_or_face"
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]
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},
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"page42": {
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"elements": [
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"h3_42",
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"low_blood_pressure"
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]
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},
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"page43": {
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"elements": [
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"h3_43",
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"slow_pulse_rate"
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]
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},
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"page44": {
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"elements": [
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"h3_44",
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"rapid_heart_rate"
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]
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},
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"page45": {
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"elements": [
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"h3_45",
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"sweaty"
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]
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},
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"page46": {
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"elements": [
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"h3_46",
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"agitated"
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]
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},
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"page47": {
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"elements": [
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"h3_47",
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"hot_feelings"
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]
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},
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"page48": {
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"elements": [
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"h3_48",
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"weight_loss"
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]
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},
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"page49": {
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"elements": [
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"h3_49",
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"difficulty_concentrating"
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]
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},
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"page50": {
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"elements": [
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"h3_50",
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"forgetful"
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]
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},
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"page51": {
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"elements": [
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"h3_51",
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"weight_gain"
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]
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},
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"page52": {
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"elements": [
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"h3_52",
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"elevated_cholesterol"
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]
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},
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"page53": {
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"elements": [
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"h3_53",
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"nervousness"
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]
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},
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"page54": {
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"elements": [
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"h3_54",
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"slow_ankle_reflex"
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]
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},
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"page55": {
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"elements": [
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"h3_55",
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"weight_loss_difficulty"
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]
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},
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"page56": {
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"elements": [
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"h3_56",
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"thinning_pubic_hair"
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]
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},
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// "disqualification": {
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// "elements": ["disqualify_message"],
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// "buttons": { "previous": false, "next": false,'finish':false },
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// "conditions": [
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// function(form$) {
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// console.log('getIsDisqualified',store.getters.getIsDisqualified)
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// if(store.getters.getIsDisqualified)
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// return true;
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// else
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// return false;
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// }
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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": "h3",
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"content": "Low Libido"
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},
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"low_libido": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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// "disqualify": "0,3",
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"rules": ["required"],
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"view": "blocks"
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},
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"h3_1": {
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"type": "static",
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"tag": "h3",
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"content": "Depression"
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},
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"depression": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_2": {
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"type": "static",
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"tag": "h3",
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"content": "Decreased Muscle Mass"
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},
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"decreased_muscle_mass": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_3": {
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"type": "static",
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"tag": "h3",
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"content": "Sleep Disturbances"
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},
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"sleep_disturbances": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_4": {
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"type": "static",
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"tag": "h3",
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"content": "Fatigue"
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},
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"fatigue": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_5": {
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"type": "static",
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"tag": "h3",
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"content": "Bone Loss"
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},
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"bone_loss": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_6": {
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"type": "static",
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"tag": "h3",
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"content": "Memory Lapses"
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},
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"memory_lapses": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_7": {
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"type": "static",
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"tag": "h3",
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"content": "Thinning Skin"
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},
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"thinning_skin": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_8": {
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"type": "static",
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"tag": "h3",
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"content": "Incontinence"
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},
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"incontinence": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_9": {
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"type": "static",
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"tag": "h3",
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"content": "Fibromyalgia"
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},
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"fibromyalgia": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
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},
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"h3_10": {
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"type": "static",
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"tag": "h3",
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"content": "Heart Palpitations"
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},
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"heart_palpitations": {
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"type": "radiogroup",
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"items": [
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{
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"value": "0",
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"label": "0"
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},
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{
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"value": "1",
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"label": "1"
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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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"rules": ["required"],
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"view": "blocks"
|
|
},
|
|
"h3_11": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Excessive Facial Hair"
|
|
},
|
|
"excessive_facial_hair": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_12": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Oily Skin"
|
|
},
|
|
"oily_skin": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_13": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Excessive Body Hair"
|
|
},
|
|
"excessive_body_hair": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_14": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Hair Loss On Scalp"
|
|
},
|
|
"hair_loss_on_scalp": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_15": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Increased Acne"
|
|
},
|
|
"increased_acne": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_16": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Irritability"
|
|
},
|
|
"irritability": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_17": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Breast Cancer (Yourself Or Family)"
|
|
},
|
|
"breast_cancer": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_18": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Elevated Triglycerides"
|
|
},
|
|
"elevated_triglycerides": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_19": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Chemical Sensitivity"
|
|
},
|
|
"chemical_sensitivity": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_20": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Cold Body Temperature"
|
|
},
|
|
"cold_body_temperature": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_21": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Sugar Cravings"
|
|
},
|
|
"sugar_cravings": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_22": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Moody"
|
|
},
|
|
"moody": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_23": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Allergies"
|
|
},
|
|
"allergies": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_24": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Arthritis"
|
|
},
|
|
"arthritis": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_25": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Stress"
|
|
},
|
|
"stress": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_26": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Aches and Pains"
|
|
},
|
|
"aches_and_pains": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_27": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Headaches"
|
|
},
|
|
"headaches": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_28": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Perspiration"
|
|
},
|
|
"perspiration": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_29": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Anxiety"
|
|
},
|
|
"anxiety": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_30": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Tired Or Exhausted"
|
|
},
|
|
"tired_or_exhausted": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_31": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Nails Brittle Or Breaking"
|
|
},
|
|
"nails_brittle_or_breaking": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_32": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Cold Hands And Feet"
|
|
},
|
|
"cold_hands_and_feet": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_33": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Dry And Brittle Hair"
|
|
},
|
|
"dry_and_brittle_hair": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_34": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Dry Skin And Hair"
|
|
},
|
|
"dry_skin_and_hair": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_35": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Hoarseness"
|
|
},
|
|
"hoarseness": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_36": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Slowed Reflexes"
|
|
},
|
|
"slowed_reflexes": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_37": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Infertility Problems"
|
|
},
|
|
"infertility_problems": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_38": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Constipation"
|
|
},
|
|
"constipation": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_39": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Decreased Sweating"
|
|
},
|
|
"decreased_sweating": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_40": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Mood Changes"
|
|
},
|
|
"mood_changes": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_41": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Swelling Puffy Eyes Or Face"
|
|
},
|
|
"swelling_puffy_eyes_or_face": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_42": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Low Blood Pressure"
|
|
},
|
|
"low_blood_pressure": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_43": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Slow Pulse Rate"
|
|
},
|
|
"slow_pulse_rate": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_44": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Rapid Heart Rate"
|
|
},
|
|
"rapid_heart_rate": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_45": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Sweaty"
|
|
},
|
|
"sweaty": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_46": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Agitated"
|
|
},
|
|
"agitated": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_47": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Hot Feelings"
|
|
},
|
|
"hot_feelings": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_48": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Weight Loss"
|
|
},
|
|
"weight_loss": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_49": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Difficulty Concentrating"
|
|
},
|
|
"difficulty_concentrating": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_50": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Forgetful"
|
|
},
|
|
"forgetful": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_51": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Weight Gain"
|
|
},
|
|
"weight_gain": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_52": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Elevated Cholesterol"
|
|
},
|
|
"elevated_cholesterol": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
// "h3_43": {
|
|
// "type": "static",
|
|
// "tag": "h3",
|
|
// "content": "Depressed Immune System"
|
|
// },
|
|
// "depressed_immune_system": {
|
|
// "type": "radiogroup",
|
|
// "items": [
|
|
// {
|
|
// "value": "0",
|
|
// "label": "0"
|
|
// },
|
|
// {
|
|
// "value": "1",
|
|
// "label": "1"
|
|
// },
|
|
// {
|
|
// "value": "2",
|
|
// "label": "2"
|
|
// },
|
|
// {
|
|
// "value": "3",
|
|
// "label": "3"
|
|
// }
|
|
// ],
|
|
// "rules": ["required"],
|
|
// "view": "blocks"
|
|
// },
|
|
"h3_53": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Nervousness"
|
|
},
|
|
"nervousness": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_54": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Slow Ankle Reflex"
|
|
},
|
|
"slow_ankle_reflex": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_55": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Weight Loss Difficulty"
|
|
},
|
|
"weight_loss_difficulty": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
"h3_56": {
|
|
"type": "static",
|
|
"tag": "h3",
|
|
"content": "Thinning Pubic Hair"
|
|
},
|
|
"thinning_pubic_hair": {
|
|
"type": "radiogroup",
|
|
"items": [
|
|
{
|
|
"value": "0",
|
|
"label": "0"
|
|
},
|
|
{
|
|
"value": "1",
|
|
"label": "1"
|
|
},
|
|
{
|
|
"value": "2",
|
|
"label": "2"
|
|
},
|
|
{
|
|
"value": "3",
|
|
"label": "3"
|
|
}
|
|
],
|
|
"rules": ["required"],
|
|
"view": "blocks"
|
|
},
|
|
// "disqualify_message": {
|
|
// "type": "static",
|
|
// "tag": "p",
|
|
// "content": "Unfortunately, you are not eligible based on your selection."
|
|
// }
|
|
}
|
|
}
|