Reference Form - Questions Library

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Reference Form - Questions Library

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This form is used to design questions that will be built in the question library. Each question must be in its own group. Consider items, layout and integrations. Choose which pages to display by selecting from the list.

Library Question Section

This is a toggle question

⛔️ Needs fixing

Default values don't count with enableWhen if you don't toggle them
Default values replaced selected values if you go forward the back page

Core Demographics

HEADER: Registrant Information

Name

Pronouns

Gender

Language

Phone

Birth date

Email

Address

Display this if "Core Demographics" EXISTS

Additional Demographics

Health card number

Primary care provider

Marital status

Custody status

Living arrangements

Alternate contact

SECTION: Alternate Contact

Name

Phone

Language

Email

Address

Relationship to registrant

Legal relationship

Health information

HEADER: Health Information

Referral urgency

Diagnosis

Reason for referral

Relevant medical history

Weight

Height

Allergies

Medications

Risk factors

Appointments

HEADER: Appointments

Conduct appointment with

Preferred contact time

Home visit information

Additional Information

HEADER: Additional Information

Attachments

Comments

Requester

*only visible to public (non-logged in form fillers)

Contact information

name, phone, employer, job title

First name

Last name

Email

Phone

Extension

Organization / Employer

Job title

Consent

Standardized consent

Placeholder text for variable names

e.g., name, contact-name
e.g., pronouns, contact-pronouns
e.g., gender, contact-gender
e.g., birth-date, birth-date
e.g., email, contact-email
e.g., phone, contact-phone
e.g., address, contact-address

Other notes

Need the "type" field for all these library items to map to the correct field (registrant, contact 1, etc...)