479 lines
12 KiB
JavaScript
479 lines
12 KiB
JavaScript
export default {
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steps: {
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page0: {
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elements: [
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'h4_5',
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'weight_lb',
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'height_feet',
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'height_inches',
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],
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},
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page1: {
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elements: [
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'h4',
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'p_4',
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'expecting',
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],
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},
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page2: {
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label: '',
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elements: [
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'h4_1',
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'p_5',
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'evaluate_weight_loss',
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],
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},
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page3: {
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label: '',
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elements: [
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'h4_2',
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'weight_management',
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],
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},
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page4: {
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label: '',
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elements: [
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'h4_3',
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'caloric_intake',
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],
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},
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page5: {
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label: '',
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elements: [
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'h4_4',
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'physical_activity',
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],
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},
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page6: {
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label: '',
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elements: [
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'h4_6',
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'weightloss_goal',
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],
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},
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page7: {
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label: '',
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elements: [
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'h4_7',
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'p_6',
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'medical_evaluation',
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],
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},
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page8: {
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label: '',
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elements: [
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'h4_8',
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'lab_tests_completed',
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],
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},
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page9: {
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label: '',
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elements: [
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'h4_9',
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'p_7',
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'comorbidities',
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],
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},
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page10: {
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label: '',
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elements: [
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'h4_10',
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'chronic_pancreatitis',
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'smoke_alcohol',
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],
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},
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page11: {
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label: '',
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elements: [
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'h4_11',
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'family_history_thyroid_cancer',
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],
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},
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page12: {
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label: '',
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elements: [
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'h4_12',
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'kindney_history',
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],
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},
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},
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schema: {
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h4_5: {
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type: 'static',
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tag: 'h4',
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content: "Let's get your numbers",
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},
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weight_lb: {
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type: 'text',
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label: 'Weight (lb) (Optional)',
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},
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height_feet: {
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type: 'text',
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label: 'Height (feet) (Optional)',
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columns: {
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container: 6,
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},
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},
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height_inches: {
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type: 'text',
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label: 'Height (inches) (Optional)',
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columns: {
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container: 6,
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},
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},
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h4: {
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type: 'static',
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tag: 'h4',
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content: 'Are you pregnant or expecting to be?',
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},
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p_4: {
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type: 'static',
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tag: 'p',
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content: 'Medications on your treatment plan might not be recommended for pregnant women.',
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},
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expecting: {
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type: 'radiogroup',
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items: [
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{
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value: 'pregnant',
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label: 'Pregnant',
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},
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{
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value: 'breastfeeding ',
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label: 'Breastfeeding or lactating',
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},
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{
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value: 'expecting_pregnant',
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label: 'Expecting to be pregnant',
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},
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{
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value: 'not_applicable',
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label: 'No or Not Applicable',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_1: {
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type: 'static',
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tag: 'h4',
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content: 'Are you here to be evaluated for weight loss?',
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},
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p_5: {
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type: 'static',
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tag: 'p',
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content: 'All responses will be evaluated by a board-certified physician. Medication may be prescribed for appropriate candidates.',
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},
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evaluate_weight_loss: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_2: {
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type: 'static',
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tag: 'h4',
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content: 'Have you ever attempted to lose weight in a weight management program?\nExamples may include caloric restriction through diet, exercise, or behavior modification.\n',
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},
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weight_management: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No, this would be my first time',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_3: {
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type: 'static',
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tag: 'h4',
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content: 'Are you willing to reduce your caloric intake alongside medication?',
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},
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caloric_intake: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_4: {
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type: 'static',
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tag: 'h4',
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content: 'Are you willing to increase your physical activity alongside medication?',
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},
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physical_activity: {
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type: 'radiogroup',
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items: [
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{
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value: 'yes',
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label: 'Yes',
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},
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{
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value: 'no',
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label: 'No',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_6: {
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type: 'static',
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tag: 'h4',
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content: 'What is your goal weight?',
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},
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weightloss_goal: {
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type: 'text',
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rules: [
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'validateTextBox',
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],
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fieldName: ' ',
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},
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h4_7: {
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type: 'static',
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tag: 'h4',
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content: 'When was the last time you had an in person medical evaluation?\n',
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},
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p_6: {
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type: 'static',
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tag: 'p',
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content: 'We want to make sure you have recently been evaluated in person by a healthcare provider.',
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},
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medical_evaluation: {
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type: 'radiogroup',
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items: [
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{
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value: 'less_then_a_year_ago',
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label: 'Less than a year ago',
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},
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{
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value: '1_to_2_years',
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label: '1 to 2 years',
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},
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{
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value: 'more_than_2_years_ago',
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label: 'More than 2 years ago',
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},
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],
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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},
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h4_8: {
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type: 'static',
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tag: 'h4',
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content: 'Have you had any lab tests completed within the last 12 months that you would like to share with your doctor?',
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},
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lab_tests_completed: {
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type: 'radiogroup',
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rules: [
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'validateRadio',
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],
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fieldName: ' ',
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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, not at this time',
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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 of the following?',
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},
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p_7: {
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type: 'static',
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tag: 'p',
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content: "These are considered 'comorbidities' by the American Board of Obesity Medicine. While you may not need to have one of these for treatment, your doctor would like to know.",
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},
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comorbidities: {
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type: 'checkboxgroup',
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items: [
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{
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value: 'high_cholesterol',
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label: 'High cholesterol',
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},
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{
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value: 'fatty_liver_disease',
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label: 'Fatty Liver Disease',
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},
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{
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value: 'high_blood_pressure',
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label: 'High Blood Pressure',
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},
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{
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value: 'pre_diabetes',
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label: 'Pre-diabetes/ Type 2 Diabetes / Hba1c above 5.7',
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},
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{
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value: 'polycystic_ovarian',
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label: 'Polycystic Ovarian Syndrome (PCOS)',
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},
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{
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value: 'none_of_the_above',
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label: 'None of the above',
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},
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],
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rules: [
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'required',
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],
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fieldName: ' ',
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},
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h4_10: {
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type: 'static',
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tag: 'h4',
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content: 'Do you have any of the following?',
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},
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chronic_pancreatitis: {
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type: 'checkboxgroup',
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items: [
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{
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value: 'chronic_pancreatitis_glp1',
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label: 'Chronic pancreatitis or previous episode of pancreatitis due to GLP-1',
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},
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{
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value: 'history_of_type1_diabetes',
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label: 'History of type 1 diabetes',
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},
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{
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value: 'history_of_severe_gl',
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label: 'History of severe GI disease (Ex: chrons disease, or ulcerative colits)',
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},
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{
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value: 'history_of_diabetic_retinopathy',
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label: 'History of diabetic retinopathy',
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},
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{
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value: 'history_of_medullary_thyroid_cancer',
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label: 'History of medullary thyroid cancer',
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},
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{
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value: 'previous_bariatric_surgery_or_other_gl_surgery',
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label: 'Previous bariatric surgery or other GI surgery',
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},
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{
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value: 'history_of_men_2',
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label: 'History of MEN-2 (multiple endocrine neoplasia syndrome type 2)',
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},
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{
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value: 'history_of_gallbladder_disease',
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label: 'History of gallbladder disease (not including gallbladder removal/cholecystectomy)',
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},
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{
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value: 'none_of_the_above',
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label: 'NONE of the above',
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},
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],
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rules: [
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'required',
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],
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fieldName: ' ',
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},
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smoke_alcohol: {
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type: 'radiogroup',
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},
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h4_11: {
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type: 'static',
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tag: 'h4',
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content: 'Does anyone in your family have a history of...',
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},
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family_history_thyroid_cancer: {
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type: 'checkboxgroup',
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items: [
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{
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value: 'men2',
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label: 'MEN2 (multiple endocrine neoplasia syndrome type 2)',
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},
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{
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value: 'medullary_thyroid_cancer',
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label: 'Medullary thyroid cancer',
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},
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{
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value: 'none_of_above_them',
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label: 'NONE of the above',
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},
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],
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rules: [
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'required',
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],
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fieldName: ' ',
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},
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h4_12: {
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type: 'static',
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tag: 'h4',
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content: 'Do you have any of the following?',
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},
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kindney_history: {
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type: 'checkboxgroup',
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items: [
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{
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value: 'history_of_kidney_failure',
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label: 'History of kidney failure',
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},
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{
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value: 'history_of_chronic_renal_failure',
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label: 'History of chronic renal failure',
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},
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{
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value: 'appointment_or_consultation_with ',
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label: 'Had an appointment or consultation with a kidney specialist in the past 12 months',
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},
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{
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value: 'history_of_solitary_kidney_or_kidney_transplant',
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label: 'History of solitary kidney, or kidney transplant',
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},
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{
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value: 'none_of_teh_above',
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label: 'None of the above ',
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},
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],
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rules: [
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'required',
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],
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fieldName: ' ',
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},
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},
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}
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