{
  "lines": [
    {
      "key": "onset",
      "helpText": "Onset: When did the problem begin? (date)",
      "resultSummary": "<b>Onset</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "location",
      "helpText": "Location: Where is the problem located?",
      "resultSummary": "<b>Location</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "duration",
      "helpText": "Duration: How long has the problem been going on for?",
      "resultSummary": "<b>Duration</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "characterization",
      "helpText": "Characterization: How does the patient describe the problem?",
      "resultSummary": "<b>Characterization</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "alleviating_factors",
      "helpText": "Alleviating Factors: What makes it better?",
      "resultSummary": "<b>Alleviating factors</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "aggravating_factors",
      "helpText": "Aggravating Factors: What makes it worse?",
      "resultSummary": "<b>Aggravating factors</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "radiation",
      "helpText": "Radiation: Does the problem move or stay in one location?",
      "resultSummary": "<b>Radiation</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "temporal_factor",
      "helpText": "Temporal factor: Is the problem worse (or better) at a certain time of the day?",
      "resultSummary": "<b>Temporal factor</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "severity",
      "helpText": "Severity: Using a scale of 1 to 10, 1 being the least, 10 being the worst, how does the patient rate the problem?",
      "resultSummary": "<b>Severity</b>: {value}",
      "fieldType": "radios",
      "options": [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]
    },
    {
      "key": "coping",
      "helpText": "Coping: How do you cope?",
      "resultSummary": "<b>Coping</b>: {value}",
      "fieldType": "text"
    },
    {
      "key": "emotional_impact",
      "helpText": "Emotional Impact: How does this affect you emotionally?",
      "resultSummary": "<b>Emotional Impact</b>: {value}",
      "fieldType": "text"
    }
  ],
  "dataMap": {
    "onset" : null,
    "location" : null,
    "duration" :  null,
    "characterization" : null,
    "alleviating_factors" :  null,
    "aggravating_factors" : null,
    "radiation" :  null,
    "temporal_factor" : null,
    "severity" :  null,
    "coping" : null,
    "emotional_impact" :  null
  }
}