Update intake JSON

gem/forms/new-patient-intake/build/form.blade.php

@@ -37,7 +37,7 @@
             </div>
 
             <div class="my-3 node node-level-2" data-key="blood_ox__ever_used_fingertip_meter__confirmed_will_discontinue_current">
-                <label>If yes, please discontinue use of that when you receive the one we send you.</label>
+                <label>If yes, can you please discontinue use of that when you receive the one we send you?</label>
             <div class="d-flex align-items-center">
                 <label class="d-inline-flex align-items-center my-0 mr-3">
                     <input name="blood_ox__ever_used_fingertip_meter__confirmed_will_discontinue_current" type="radio" value="YES" class="mr-1">
@@ -145,7 +145,7 @@
             </div>
 
             <div class="my-3 node node-level-2" data-key="blood_ox__o2_and_activity__baseline_o2_assessment">
-                <label>Once you receive the oxygen meter, we will need to call you to make sure you take a proper baseline resting measurement, and then another measurement after you have you walk for 1 minute. When is the best time and number to call usually?</label>
+                <label>Once you receive the oxygen meter, our nurse will need to call you to make sure you take a proper baseline resting measurement, and then another measurement after you walk at a normal speed for 1 minute. When is the best time and number to call usually?</label>
             <div class="d-flex align-items-center">
                 <input name="blood_ox__o2_and_activity__baseline_o2_assessment" type="text" class="form-control form-control-sm mr-2" placeholder="Answer">
                 <input name="blood_ox__o2_and_activity__baseline_o2_assessment_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
@@ -187,25 +187,6 @@
             </div>
             </div>
 
-            <div class="my-3 node node-level-2" data-key="blood_ox__o2_and_activity__has_covid_made_you_less_physically_active">
-                <label>Has the COVID-19 pandemic made you less physically active than you were before?</label>
-            <div class="d-flex align-items-center">
-                <label class="d-inline-flex align-items-center my-0 mr-3">
-                    <input name="blood_ox__o2_and_activity__has_covid_made_you_less_physically_active" type="radio" value="YES" class="mr-1">
-                    <span>Yes</span>
-                </label>
-                <label class="d-inline-flex align-items-center my-0 mr-3">
-                    <input name="blood_ox__o2_and_activity__has_covid_made_you_less_physically_active" type="radio" value="NO" class="mr-1">
-                    <span>No</span>
-                </label>
-                <label class="d-inline-flex align-items-center my-0 mr-3">
-                    <input name="blood_ox__o2_and_activity__has_covid_made_you_less_physically_active" type="radio" value="UNKNOWN" class="mr-1">
-                    <span>Unknown</span>
-                </label>
-                <input name="blood_ox__o2_and_activity__has_covid_made_you_less_physically_active_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
-            </div>
-            </div>
-
 </div>        </div>
 
 </div>    </div>
@@ -249,7 +230,7 @@
             </div>
 
             <div class="my-3 node node-level-2" data-key="pulse_and_bp__ever_used_auto_pulse_bp_meter__confirmed_will_discontinue_current">
-                <label>If yes, please discontinue use of that when you receive the one we send you.</label>
+                <label>If yes, can you please discontinue use of that when you receive the one we send you?</label>
             <div class="d-flex align-items-center">
                 <label class="d-inline-flex align-items-center my-0 mr-3">
                     <input name="pulse_and_bp__ever_used_auto_pulse_bp_meter__confirmed_will_discontinue_current" type="radio" value="YES" class="mr-1">
@@ -361,6 +342,14 @@
 
         <div class="my-3 node node-level-1" data-key="pulse_and_bp__pcp_or_other_doc_bp_target">
             <label>Has your primary care physician, or another doctor, ever told you what your target BP should be?</label>
+        <div class="d-flex align-items-center">
+            <input name="pulse_and_bp__pcp_or_other_doc_bp_target" type="text" class="form-control form-control-sm" placeholder="Answer">
+            <label class="d-inline-flex align-items-center my-0 ml-3 mr-2">
+                <input name="pulse_and_bp__pcp_or_other_doc_bp_target" type="checkbox" class="mr-1">
+                <span>Unknown</span>
+            </label>
+            <input name="pulse_and_bp__pcp_or_other_doc_bp_target_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+        </div>
 <div class="subs pl-4">            <div class="my-3 node node-level-2" data-key="pulse_and_bp__pcp_or_other_doc_bp_target__systolic">
                 <label>Systolic</label>
             <div class="d-flex align-items-center">
@@ -483,7 +472,45 @@
 
     <div class="my-3 node node-level-0" data-key="bmi">
         <label>BMI</label>
-<div class="subs pl-4">        <div class="my-3 node node-level-1" data-key="bmi__current">
+<div class="subs pl-4">        <div class="my-3 node node-level-1" data-key="bmi__has_one">
+            <label>Do you currently have one at home?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="bmi__has_one" type="radio" value="YES" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="bmi__has_one" type="radio" value="NO" class="mr-1">
+                <span>No</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="bmi__has_one" type="radio" value="UNKNOWN" class="mr-1">
+                <span>Unknown</span>
+            </label>
+            <input name="bmi__has_one_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+        </div>
+<div class="subs pl-4">            <div class="my-3 node node-level-2" data-key="bmi__has_one__confirmed_will_discontinue_current">
+                <label>If yes, can you please discontinue use of that when you receive the one we send you?</label>
+            <div class="d-flex align-items-center">
+                <label class="d-inline-flex align-items-center my-0 mr-3">
+                    <input name="bmi__has_one__confirmed_will_discontinue_current" type="radio" value="YES" class="mr-1">
+                    <span>Yes</span>
+                </label>
+                <label class="d-inline-flex align-items-center my-0 mr-3">
+                    <input name="bmi__has_one__confirmed_will_discontinue_current" type="radio" value="NO" class="mr-1">
+                    <span>No</span>
+                </label>
+                <label class="d-inline-flex align-items-center my-0 mr-3">
+                    <input name="bmi__has_one__confirmed_will_discontinue_current" type="radio" value="UNKNOWN" class="mr-1">
+                    <span>Unknown</span>
+                </label>
+                <input name="bmi__has_one__confirmed_will_discontinue_current_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+            </div>
+            </div>
+
+</div>        </div>
+
+        <div class="my-3 node node-level-1" data-key="bmi__current">
             <label>What is your current:</label>
 <div class="subs pl-4">            <div class="my-3 node node-level-2" data-key="bmi__current__height_in_inches">
                 <label>Height in inches?</label>
@@ -595,6 +622,299 @@
         </div>
         </div>
 
+</div>    </div>
+
+    <div class="my-3 node node-level-0" data-key="current_focus_areas">
+        <label>As you know, you get three things with this program: 1) dedicated NP, 2) 24/7 access to the hotline, and 3) self-monitoring kit. What conditions or health goals do you have that you would like to see improve by participating in this program?</label>
+    <div class="mt-3">
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="High Blood Pressure" type="checkbox" class="mr-1">
+            <span>High Blood Pressure</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Heart Disease" type="checkbox" class="mr-1">
+            <span>Heart Disease</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Diabetes" type="checkbox" class="mr-1">
+            <span>Diabetes</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Chronic Lung Disease or COPD" type="checkbox" class="mr-1">
+            <span>Chronic Lung Disease or COPD</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="High Cholesterol" type="checkbox" class="mr-1">
+            <span>High Cholesterol</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Heart Failure" type="checkbox" class="mr-1">
+            <span>Heart Failure</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Atherosclerotic Disease ('Clogged Artery')" type="checkbox" class="mr-1">
+            <span>Atherosclerotic Disease ('Clogged Artery')</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Cancer" type="checkbox" class="mr-1">
+            <span>Cancer</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Stroke" type="checkbox" class="mr-1">
+            <span>Stroke</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Alzheimer's" type="checkbox" class="mr-1">
+            <span>Alzheimer's</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Diabetes" type="checkbox" class="mr-1">
+            <span>Diabetes</span>
+        </label>
+        <label class="d-flex align-items-center mb-1 mr-2">
+            <input name="current_focus_areas[]" value="Kidney Disease" type="checkbox" class="mr-1">
+            <span>Kidney Disease</span>
+        </label>
+        <input name="current_focus_areas_other" type="text" class="form-control form-control-sm my-3" placeholder="Other">
+    </div>
+    </div>
+
+    <div class="my-3 node node-level-0" data-key="consent">
+        <label>Consent:</label>
+<div class="subs pl-4">        <div class="my-3 node node-level-1" data-key="consent__to_be_treated_and_use_equipment_as_directed">
+            <label>Do you agree to be treated for the above {{current_focus_areas}} by our board-certified nurse practitioners using self-monitoring equipment as directed for safety purposes - and do you understand that improper use of the equipment may cause false readings and possible harm?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__to_be_treated_and_use_equipment_as_directed" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__to_be_treated_and_use_equipment_as_directed" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="consent__np_to_do_consult">
+            <label>I have to transfer this call over to the on call NP, who will conduct an initial consultation and sign the equipment order.</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__np_to_do_consult" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__np_to_do_consult" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="consent__np_will_be_poc">
+            <label>She'll be your dedicated point of contact here.</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__np_will_be_poc" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__np_will_be_poc" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="consent__confirm_ox_follow_up">
+            <label>As we discussed earlier, once you receive the oxygen meter, your dedicated NP will follow up again in a few days, it can be simply over the phone or video call if needed, to get a baseline resting and active oxygen reading. Number to call: {{blood_ox__o2_and_activity__baseline_o2_assessment__best_time_to_call}}, Time to call: {{blood_ox__o2_and_activity__baseline_o2_assessment__best_number_to_call}}.</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__confirm_ox_follow_up" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__confirm_ox_follow_up" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="consent__monthly_follow_up">
+            <label>After you are set up, your dedicated NP is required to call you monthly to make sure that you are okay and that the equipment is working properly.</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__monthly_follow_up" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__monthly_follow_up" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="consent__package">
+            <label>The equipment will come in two packages. First the temperature gun and oxygen meter. Then when we have confirmation that you successfully received the first package and got your baseline oxygen measurement, we will send out the second package which contains the BP cuff and weight scale.</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__package" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__package" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="consent__video_call">
+            <label>This first call with the NP, to sign the order, has to be a video call.</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__video_call" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__video_call" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="consent__later_phone_call">
+            <label>This is the only time a video call is required - if you need anything in the future it can be over a normal phone call.</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__later_phone_call" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="consent__later_phone_call" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+</div>    </div>
+
+    <div class="my-3 node node-level-0" data-key="ever_had_a_video_call_with_hcp">
+        <label>Have you ever had a video call with one of your other doctors before?</label>
+    <div class="d-flex align-items-center">
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="ever_had_a_video_call_with_hcp" type="radio" value="YES" class="mr-1">
+            <span>Yes</span>
+        </label>
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="ever_had_a_video_call_with_hcp" type="radio" value="NO" class="mr-1">
+            <span>No</span>
+        </label>
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="ever_had_a_video_call_with_hcp" type="radio" value="UNKNOWN" class="mr-1">
+            <span>Unknown</span>
+        </label>
+        <input name="ever_had_a_video_call_with_hcp_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+    </div>
+<div class="subs pl-4">        <div class="my-3 node node-level-1" data-key="ever_had_a_video_call_with_hcp__how_did_you_do_it">
+            <label>How did you do it?</label>
+        <div class="d-flex align-items-center">
+            <input name="ever_had_a_video_call_with_hcp__how_did_you_do_it" type="text" class="form-control form-control-sm mr-2" placeholder="Answer">
+            <input name="ever_had_a_video_call_with_hcp__how_did_you_do_it_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="ever_had_a_video_call_with_hcp__how_did_you_like_it">
+            <label>How did you like it?</label>
+        <div class="d-flex align-items-center">
+            <input name="ever_had_a_video_call_with_hcp__how_did_you_like_it" type="text" class="form-control form-control-sm mr-2" placeholder="Answer">
+            <input name="ever_had_a_video_call_with_hcp__how_did_you_like_it_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+        </div>
+        </div>
+
+</div>    </div>
+
+    <div class="my-3 node node-level-0" data-key="mobile_phone">
+        <label>What kind of cell phone do you have?</label>
+    <div class="d-flex align-items-center">
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="mobile_phone" type="radio" value="YES" class="mr-1">
+            <span>Yes</span>
+        </label>
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="mobile_phone" type="radio" value="NO" class="mr-1">
+            <span>No</span>
+        </label>
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="mobile_phone" type="radio" value="UNKNOWN" class="mr-1">
+            <span>Unknown</span>
+        </label>
+        <input name="mobile_phone_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+    </div>
+<div class="subs pl-4">        <div class="my-3 node node-level-1" data-key="mobile_phone__type">
+            <label>Type of phone:</label>
+        <div class="d-flex align-items-center">
+            <input name="mobile_phone__type" type="text" class="form-control form-control-sm mr-2" placeholder="Answer">
+            <input name="mobile_phone__type_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="mobile_phone__ever_done_video_call_with_phone">
+            <label>Have you ever done a video call with your phone before?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="mobile_phone__ever_done_video_call_with_phone" type="radio" value="YES" class="mr-1">
+                <span>Yes</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="mobile_phone__ever_done_video_call_with_phone" type="radio" value="NO" class="mr-1">
+                <span>No</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="mobile_phone__ever_done_video_call_with_phone" type="radio" value="UNKNOWN" class="mr-1">
+                <span>Unknown</span>
+            </label>
+            <input name="mobile_phone__ever_done_video_call_with_phone_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+        </div>
+        </div>
+
+</div>    </div>
+
+    <div class="my-3 node node-level-0" data-key="video_call_now">
+        <label>Can we do the video call now?</label>
+    <div class="d-flex align-items-center">
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="video_call_now" type="radio" value="YES" class="mr-1">
+            <span>Yes</span>
+        </label>
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="video_call_now" type="radio" value="NO" class="mr-1">
+            <span>No</span>
+        </label>
+        <label class="d-inline-flex align-items-center my-0 mr-3">
+            <input name="video_call_now" type="radio" value="UNKNOWN" class="mr-1">
+            <span>Unknown</span>
+        </label>
+        <input name="video_call_now_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+    </div>
+<div class="subs pl-4">        <div class="my-3 node node-level-1" data-key="video_call_now__get_on_call_np">
+            <label>If yes, I can bring the on-call NP on the line and they'll get you all set up. OK?</label>
+        <div class="d-flex align-items-center">
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="video_call_now__get_on_call_np" type="radio" value="ACCEPT" class="mr-1">
+                <span>Accept</span>
+            </label>
+            <label class="d-inline-flex align-items-center my-0 mr-3">
+                <input name="video_call_now__get_on_call_np" type="radio" value="REJECT" class="mr-1">
+                <span>Reject</span>
+            </label>
+        </div>
+        </div>
+
+        <div class="my-3 node node-level-1" data-key="video_call_now__when">
+            <label>If not, when is a good time?</label>
+        <div class="d-flex align-items-center">
+            <input name="video_call_now__when" type="text" class="form-control form-control-sm mr-2" placeholder="Answer">
+            <input name="video_call_now__when_memo" type="text" class="form-control form-control-sm" placeholder="Memo">
+        </div>
+        </div>
+
 </div>    </div>
 
 </div>

gem/forms/new-patient-intake/spec.json

@@ -1,3 +1,4 @@
+
 [
     {
         "Q": "Blood Oxygen",
@@ -14,7 +15,7 @@
                         "K": "has_one"
                     },
                     {
-                        "Q": "If yes, please discontinue use of that when you receive the one we send you.",
+                        "Q": "If yes, can you please discontinue use of that when you receive the one we send you?",
                         "T": "YNUM",
                         "K": "confirmed_will_discontinue_current"
                     }
@@ -55,7 +56,7 @@
                         "K": "ever_had_o2_checked_before_after_exercise"
                     },
                     {
-                        "Q": "Once you receive the oxygen meter, we will need to call you to make sure you take a proper baseline resting measurement, and then another measurement after you have you walk for 1 minute. When is the best time and number to call usually?",
+                        "Q": "Once you receive the oxygen meter, our nurse will need to call you to make sure you take a proper baseline resting measurement, and then another measurement after you walk at a normal speed for 1 minute. When is the best time and number to call usually?",
                         "T": "Text with Memo",
                         "K": "baseline_o2_assessment",
                         "S": [
@@ -71,11 +72,6 @@
                             }
                         ]
                     },
-                    {
-                        "Q": "Has the COVID-19 pandemic made you less physically active than you were before?",
-                        "T": "YNUM",
-                        "K": "has_covid_made_you_less_physically_active"
-                    },
                     {
                         "Q": "Has the COVID-19 pandemic made you less physically active than you were before?",
                         "T": "YNUM",
@@ -100,7 +96,7 @@
                         "K": "has_one"
                     },
                     {
-                        "Q": "If yes, please discontinue use of that when you receive the one we send you.",
+                        "Q": "If yes, can you please discontinue use of that when you receive the one we send you?",
                         "T": "YNUM",
                         "K": "confirmed_will_discontinue_current"
                     }
@@ -147,6 +143,7 @@
             {
                 "Q": "Has your primary care physician, or another doctor, ever told you what your target BP should be?",
                 "K": "pcp_or_other_doc_bp_target",
+                "T": "SRV",
                 "S": [
                     {
                         "Q": "Systolic",
@@ -199,6 +196,18 @@
         "Q": "BMI",
         "K": "bmi",
         "S": [
+            {
+                "Q": "Do you currently have one at home?",
+                "T": "YNUM",
+                "K": "has_one",
+                "S": [
+                    {
+                        "Q": "If yes, can you please discontinue use of that when you receive the one we send you?",
+                        "T": "YNUM",
+                        "K": "confirmed_will_discontinue_current"
+                    }
+                ]
+            },
             {
                 "Q": "What is your current:",
                 "K": "current",
@@ -219,6 +228,7 @@
                         "T": "SRV"
                     },
                     {
+                        "Skip": true,
                         "Q": "Body fat %?",
                         "K": "body_fat_percent",
                         "T": "SRV"
@@ -257,5 +267,123 @@
                 "T": "Text with Memo"
             }
         ]
+    },
+
+    {
+        "Q": "As you know, you get three things with this program: 1) dedicated NP, 2) 24/7 access to the hotline, and 3) self-monitoring kit. What conditions or health goals do you have that you would like to see improve by participating in this program?",
+        "K": "current_focus_areas",
+        "T": "Multi Checkbox with Other",
+        "Options": [
+            "High Blood Pressure",
+            "Heart Disease",
+            "Diabetes",
+            "Chronic Lung Disease or COPD",
+            "High Cholesterol",
+            "Heart Failure",
+            "Atherosclerotic Disease ('Clogged Artery')",
+            "Cancer",
+            "Stroke",
+            "Alzheimer's",
+            "Diabetes",
+            "Kidney Disease"
+        ]
+    },
+    {
+        "Q": "Consent:",
+        "K": "consent",
+        "S": [
+            {
+                "Q": "Do you agree to be treated for the above {{current_focus_areas}} by our board-certified nurse practitioners using self-monitoring equipment as directed for safety purposes - and do you understand that improper use of the equipment may cause false readings and possible harm?",
+                "K": "to_be_treated_and_use_equipment_as_directed",
+                "T": "Accept"
+            },
+            {
+                "Q": "I have to transfer this call over to the on call NP, who will conduct an initial consultation and sign the equipment order.",
+                "K": "np_to_do_consult",
+                "T": "Accept"
+            },
+            {
+                "Q": "She'll be your dedicated point of contact here.",
+                "K": "np_will_be_poc",
+                "T": "Accept"
+            },
+            {
+                "Q": "As we discussed earlier, once you receive the oxygen meter, your dedicated NP will follow up again in a few days, it can be simply over the phone or video call if needed, to get a baseline resting and active oxygen reading. Number to call: {{blood_ox__o2_and_activity__baseline_o2_assessment__best_time_to_call}}, Time to call: {{blood_ox__o2_and_activity__baseline_o2_assessment__best_number_to_call}}.",
+                "K": "confirm_ox_follow_up",
+                "T": "Accept"
+            },
+            {
+                "Q": "After you are set up, your dedicated NP is required to call you monthly to make sure that you are okay and that the equipment is working properly.",
+                "K": "monthly_follow_up",
+                "T": "Accept"
+            },
+            {
+                "Q": "The equipment will come in two packages. First the temperature gun and oxygen meter. Then when we have confirmation that you successfully received the first package and got your baseline oxygen measurement, we will send out the second package which contains the BP cuff and weight scale.",
+                "K": "package",
+                "T": "Accept"
+            },
+            {
+                "Q": "This first call with the NP, to sign the order, has to be a video call.",
+                "K": "video_call",
+                "T": "Accept"
+            },
+            {
+                "Q": "This is the only time a video call is required - if you need anything in the future it can be over a normal phone call.",
+                "K": "later_phone_call",
+                "T": "Accept"
+            }
+        ]
+    },
+    {
+        "Q": "Have you ever had a video call with one of your other doctors before?",
+        "K": "ever_had_a_video_call_with_hcp",
+        "T": "YNUM",
+        "S": [
+            {
+                "Q": "How did you do it?",
+                "K": "how_did_you_do_it",
+                "T": "Text with Memo"
+            },
+            {
+                "Skip": true,
+                "Q": "How did you like it?",
+                "K": "how_did_you_like_it",
+                "T": "Text with Memo"
+            }
+        ]
+    },
+    {
+        "Q": "What kind of cell phone do you have?",
+        "K": "mobile_phone",
+        "T": "YNUM",
+        "S": [
+            {
+                "Q": "Type of phone:",
+                "K": "type",
+                "T": "Text with Memo"
+            },
+            {
+                "Q": "Have you ever done a video call with your phone before?",
+                "K": "ever_done_video_call_with_phone",
+                "T": "YNUM"
+            }
+        ]
+    },
+    {
+        "Q": "Can we do the video call now?",
+        "K": "video_call_now",
+        "T": "YNUM",
+        "S": [
+            {
+                "Q": "If yes, I can bring the on-call NP on the line and they'll get you all set up. OK?",
+                "K": "get_on_call_np",
+                "T": "Accept"
+            },
+            {
+                "Q": "If not, when is a good time?",
+                "K": "when",
+                "T": "Text with Memo"
+            }
+        ]
     }
 ]