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preset_form_Russian.json
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{
"FormName": "Chiro Form",
"FormId": "76",
"PatientId": null,
"DoctorId": null,
"DoctorLocationId": null,
"AppointmentId": null,
"DateCompleted": null,
"DateUpdated": null,
"FormSelectedTemplateID": 0,
"FormSections": [
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"SectionQuestions": [
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"SectionId": "45",
"QuestionId": "1137",
"QuestionParentId": "1134",
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"QuestionText": "Interpreter was a",
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"ParentQuestionId": "1137",
"OptionText": "Spanish interpreter",
"OptionId": "1378",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1137",
"OptionText": "Russian interpreter",
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"ConditionTriggerId": "",
"Chosen": true
},
{
"ParentQuestionId": "1137",
"OptionText": "Chinese interpreter",
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},
{
"ParentQuestionId": "1137",
"OptionText": "Korean interpreter",
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"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1137",
"OptionText": "French Creole interpreter",
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"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1137",
"OptionText": "Sign language interpreter",
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"ConditionTriggerId": "",
"Chosen": false
}
]
},
{
"SectionId": "45",
"QuestionId": "1138",
"QuestionParentId": "1135",
"QuestionType": "Numeric",
"QuestionText": "How many months pregnant?",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "487",
"ActiveTriggerId": null,
"IsConditional": true,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
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},
{
"SectionId": "45",
"QuestionId": "1139",
"QuestionParentId": "1136",
"QuestionType": "Radio",
"QuestionText": "The minor was present with",
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"ActiveTriggerId": null,
"IsConditional": true,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
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"ParentQuestionId": "1139",
"OptionText": "Present with Adult",
"OptionId": "1384",
"ConditionTriggerId": "",
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{
"ParentQuestionId": "1139",
"OptionText": "Mother",
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"ConditionTriggerId": "",
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"ParentQuestionId": "1139",
"OptionText": "Father",
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"ConditionTriggerId": "",
"Chosen": false
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{
"ParentQuestionId": "1139",
"OptionText": "Legal Guardian",
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"ConditionTriggerId": "",
"Chosen": false
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{
"ParentQuestionId": "1139",
"OptionText": "Paralegal",
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"ConditionTriggerId": "",
"Chosen": false
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{
"ParentQuestionId": "1139",
"OptionText": "Legal Representative",
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"ConditionTriggerId": "",
"Chosen": false
}
]
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{
"SectionId": "45",
"QuestionId": "1134",
"QuestionParentId": "0",
"QuestionType": "YesNo",
"QuestionText": "Did claimant communicate via interpreter?",
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"AnswerId": "",
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"IsAnswered": false,
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"OptionText": "Yes",
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"ConditionTriggerId": "486",
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"SectionId": "45",
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{
"SectionId": "45",
"QuestionId": "1136",
"QuestionParentId": "0",
"QuestionType": "YesNo",
"QuestionText": "Is claimant a Minor?",
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"ParentConditionTriggerId": "",
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"IsConditional": false,
"AnswerId": "",
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"OptionText": "Yes",
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"ConditionTriggerId": "488",
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{
"ParentQuestionId": "1136",
"OptionText": "No",
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"ConditionTriggerId": "",
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}
]
}
]
},
{
"SectionName": "General Observation",
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"SectionSelectedTemplateID": 0,
"SectionQuestions": [
{
"SectionId": "46",
"QuestionId": "1148",
"QuestionParentId": "1141",
"QuestionType": "Radio",
"QuestionText": "There is a mild limp and mild antalgic gait to",
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"ParentConditionTriggerId": "489",
"ActiveTriggerId": null,
"IsConditional": true,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": [
{
"ParentQuestionId": "1148",
"OptionText": "Right",
"OptionId": "1406",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1148",
"OptionText": "Left",
"OptionId": "1407",
"ConditionTriggerId": "",
"Chosen": true
},
{
"ParentQuestionId": "1148",
"OptionText": "Both",
"OptionId": "1408",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1148",
"OptionText": "Lower extremities",
"OptionId": "1409",
"ConditionTriggerId": "",
"Chosen": false
}
]
},
{
"SectionId": "46",
"QuestionId": "1141",
"QuestionParentId": "0",
"QuestionType": "Boolean",
"QuestionText": "No limp or antalgic gait observed",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": [
{
"ParentQuestionId": "1141",
"OptionText": "True",
"OptionId": "22",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1141",
"OptionText": "False",
"OptionId": "23",
"ConditionTriggerId": "489",
"Chosen": false
}
]
},
{
"SectionId": "46",
"QuestionId": "1142",
"QuestionParentId": "0",
"QuestionType": "YesNo",
"QuestionText": "Grimacing during entire exam",
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"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": [
{
"ParentQuestionId": "1142",
"OptionText": "Yes",
"OptionId": "7",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1142",
"OptionText": "No",
"OptionId": "8",
"ConditionTriggerId": "",
"Chosen": false
}
]
},
{
"SectionId": "46",
"QuestionId": "1143",
"QuestionParentId": "0",
"QuestionType": "Radio",
"QuestionText": "Claimant is using",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": [
{
"ParentQuestionId": "1143",
"OptionText": "no aid",
"OptionId": "1390",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1143",
"OptionText": "straight cane",
"OptionId": "1391",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1143",
"OptionText": "lumbar support",
"OptionId": "1392",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1143",
"OptionText": "cervical collar",
"OptionId": "1393",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1143",
"OptionText": "walker",
"OptionId": "1394",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1143",
"OptionText": "R knee brace",
"OptionId": "1395",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1143",
"OptionText": "L knee brace",
"OptionId": "1396",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1143",
"OptionText": "wheelchair",
"OptionId": "1397",
"ConditionTriggerId": "",
"Chosen": false
}
]
},
{
"SectionId": "46",
"QuestionId": "1144",
"QuestionParentId": "0",
"QuestionType": "TextInput",
"QuestionText": "Abrasion/Laceration scar to (healed):",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": null
},
{
"SectionId": "46",
"QuestionId": "1145",
"QuestionParentId": "0",
"QuestionType": "TextInput",
"QuestionText": "Abrasion/Laceration scar to (healing):",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": null
},
{
"SectionId": "46",
"QuestionId": "1146",
"QuestionParentId": "0",
"QuestionType": "Check",
"QuestionText": "Arthroscopic surgical scar",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": [
{
"ParentQuestionId": "1146",
"OptionText": "to right knee healed",
"OptionId": "1398",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1146",
"OptionText": "to left knee healed",
"OptionId": "1399",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1146",
"OptionText": "right shoulder healed",
"OptionId": "1400",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1146",
"OptionText": "left shoulder healed",
"OptionId": "1401",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1146",
"OptionText": "to right knee healing",
"OptionId": "1402",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1146",
"OptionText": "to left knee healing",
"OptionId": "1403",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1146",
"OptionText": "right shoulder healing",
"OptionId": "1404",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1146",
"OptionText": "left shoulder healing",
"OptionId": "1405",
"ConditionTriggerId": "",
"Chosen": false
}
]
},
{
"SectionId": "46",
"QuestionId": "1147",
"QuestionParentId": "0",
"QuestionType": "TextInput",
"QuestionText": "Additional Notes",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": null
}
]
},
{
"SectionName": "Cervical Spine",
"SectionId": "47",
"SectionSelectedTemplateID": 0,
"SectionQuestions": [
{
"SectionId": "47",
"QuestionId": "1152",
"QuestionParentId": "1151",
"QuestionType": "Boolean",
"QuestionText": "- extremely light touch to the top of the head causes the patient to complain of pain inconsistent with the amount of pressure used",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "491",
"ActiveTriggerId": null,
"IsConditional": true,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": [
{
"ParentQuestionId": "1152",
"OptionText": "True",
"OptionId": "22",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1152",
"OptionText": "False",
"OptionId": "23",
"ConditionTriggerId": "",
"Chosen": false
}
]
},
{
"SectionId": "47",
"QuestionId": "1149",
"QuestionParentId": "0",
"QuestionType": "Radio",
"QuestionText": "Is the Cervical Spine normal?",
"QuestionKeyboardType": null,
"ParentConditionTriggerId": "",
"ActiveTriggerId": null,
"IsConditional": false,
"AnswerId": "",
"AnswerText": "",
"IsAnswered": false,
"IsEnabled": false,
"AnswerOptionIndex": null,
"QuestionOptions": [
{
"ParentQuestionId": "1149",
"OptionText": "normal reading",
"OptionId": "1410",
"ConditionTriggerId": "",
"Chosen": false
},
{
"ParentQuestionId": "1149",
"OptionText": "not normal",
"OptionId": "1411",
"ConditionTriggerId": "490",
"Chosen": false
},
{
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