alpaca
Version:
Alpaca provides the easiest and fastest way to generate interactive forms for the web and mobile devices. It runs simply as HTML5 or more elaborately using Bootstrap, jQuery Mobile or jQuery UI. Alpaca uses Handlebars to process JSON schema and provide
412 lines (410 loc) • 11.3 kB
JSON
{
"fields": {
"last_menstrual_period": {
"label": "Date of Last Menstrual Period:",
"type": "date",
"dateFormat": "yy-mm-dd",
"datepicker": {
"hideIfNoPrevNextType": true,
"yearRange": "2010:+10",
"changeMonth": true,
"changeYear": true
}
},
"due_date": {
"label": "Expected Due Date:",
"type": "date",
"dateFormat": "yy-mm-dd",
"datepicker": {
"hideIfNoPrevNextType": true,
"yearRange": "2010:+10",
"changeMonth": true,
"changeYear": true
}
},
"date_gestationalage": {
"type": "hidden"
},
"current_gestationalage_weeks": {
"label": "Approximate Estimated Gestational Age (weeks):",
"type": "select"
},
"number_pregnancy": {
"label": "Pregnancy Number:",
"type": "select"
},
"pregnancy_test": {
"label": "Positive Pregnancy Test?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"number_full_term_delivery": {
"label": "Number of Previous Full Term Deliveries:",
"type": "select"
},
"number_pre_term_delivery": {
"label": "Number of Previous Preterm Deliveries:",
"type": "select"
},
"number_miscarriage_abortion": {
"label": "Number of Previous Miscarriages/Abortions:",
"type": "select"
},
"number_live_birth": {
"label": "Number of Previous Live Births:",
"type": "select"
},
"weight_heaviest_infant": {
"label": "Approximate Weight of Heaviest Infant Previously Delivered:",
"type": "select"
},
"pregnancy_complications": {
"label": "Complications in Previous Pregnancies:",
"type": "checkbox"
},
"other_pregnancy_complications": {
"label": "If Other Pregnancy Complication, Please Describe:"
},
"pregnancy_diseases": {
"label": "Diseases:",
"type": "checkbox"
},
"std_status": {
"label": "Infected with STD",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"std_treatment": {
"label": "Being treated for STD",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"hiv_status_prior_firstvisit": {
"label": "HIV Status prior to first visit",
"type": "radio",
"removeDefaultNone": true
},
"tested_hiv_firstvisit": {
"label": "Tested for HIV on first visit?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"first_hiv_status": {
"label": "Result if tested for HIV on first visit",
"type": "radio",
"removeDefaultNone": true
},
"second_hiv_test": {
"label": "Tested positive by second HIV test?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"refer_ctc": {
"label": "Referred to CTC?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"partner_hiv": {
"label": "Partner tested for HIV in clinic?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"partner_positive": {
"label": "Partner tested positive for HIV?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"discordant_couple": {
"label": "Discordant couple?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"combo_drugs": {
"label": "Patient recieved PMCTC combo drugs?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"art_drugs": {
"label": "Patient using ART?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"ctx_given": {
"label": "Patient given CTX?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"counsel_feeding": {
"label": "Counseled on how to feed the baby?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"syphillus_test": {
"label": "Tested for Syphillus",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"syphillus_status": {
"label": "Infected with Syphillus",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"syphillus_treatment": {
"label": "Being treated for Syphillus",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"partner_std": {
"label": "Partner infected with STD",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"partner_std_treatment": {
"label": "Partner being treated for STD",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"partner_syphillus_test": {
"label": "Partner infected with Syphillus",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"partner_syphillus_status": {
"label": "Partner infected with Syphillus",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"partner_syphillus_treatment": {
"label": "Partner being treated for Syphillus",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"malaria_test": {
"label": "Tested for malaria?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"malar_pos": {
"label": "Tested positive for malaria?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"bednet_voucher": {
"label": "Given voucher for free bednet?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"ipt1": {
"label": "Given IPT1?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"ipt2": {
"label": "Given IPT2?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"bp_systolic": {
"label": "BP Systolic",
"type": "number"
},
"bp_diastolic": {
"label": "BP Diastolic",
"type": "number"
},
"anemia_severe": {
"label": "Severe Anemia (>8.5g/dl)",
"type": "select"
},
"symptoms": {
"label": "Symptoms:",
"type": "checkbox"
},
"tt2plus_vaccine": {
"label": "Received vaccination of TT2+",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"other_symptoms": {
"label": "If Other Symptom, Please Describe:"
},
"fundal_height": {
"label": "Fundal Height (cm):",
"type": "select"
},
"fetal_heart_rate": {
"label": "Fetal Heart Rate (Beats Per Minute):",
"type": "select"
},
"treatment_given": {
"label": "If Any Treatment Given, Please Describe:",
"type": "textarea"
},
"iron_tablets": {
"label": "Given iron tablets?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"alben_tablets": {
"label": "Given albendazole?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"notes": {
"label": "Examination Notes:",
"type": "textarea"
},
"admission": {
"label": "Admission Required Today?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"referral": {
"label": "Referral?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"referred_ctc": {
"label": "Mother Referred To CTC?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
},
"in_labor": {
"label": "Laboring Now?",
"type": "radio",
"enum": [
"Yes",
"No"
],
"removeDefaultNone": true
}
}
}