VitalApp/assets/templates/FollowUpTuberculosisRecord.json

{
  "Key": "FollowUpTuberculosisRecord",
  "Name": "肺结核患者随访服务记录表",
  "Content": [
    {
      "label": "基本信息",
      "defaultValue": [],
      "span": 12,
      "key": "BasicInfo",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "治疗月序",
          "defaultValue": [],
          "span": 24,
          "key": "Month",
          "type": "input",
          "border": false,
          "disabledValue": "0",
          "options": [],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "BasicInfo",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": []
        },
        {
          "label": "督导人员选择",
          "defaultValue": [],
          "span": 24,
          "key": "Supervisor",
          "type": "radio",
          "border": false,
          "disabledValue": "1",
          "options": [
            {
              "label": "医生",
              "value": "1"
            },
            {
              "label": "家属",
              "value": "2"
            },
            {
              "label": "自服药",
              "value": "3"
            },
            {
              "label": "其他",
              "value": "4"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "Medication",
          "buttonName": null,
          "childrenKey": ["Supervisor_Other"],
          "groupKeys": ["4"]
        }
      ],
      "append": null,
      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": "",
      "buttonName": null,
      "childrenKey": null,
      "groupKeys": []
    },
    {
      "label": "症状",
      "defaultValue": [],
      "span": 24,
      "key": "Symptomatic",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "症状及体征",
          "defaultValue": [],
          "span": 24,
          "key": "Symptom",
          "type": "checkBoxIncludeOther",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "没有症状",
              "value": "0"
            },
            {
              "label": " 咳嗽咳痰",
              "value": "1"
            },
            {
              "label": "低热盗汗",
              "value": "2"
            },
            {
              "label": "咯血或血痰",
              "value": "3"
            },
            {
              "label": "胸痛消瘦",
              "value": "4"
            },
            {
              "label": "恶心纳差",
              "value": "5"
            },
            {
              "label": "关节疼痛",
              "value": "6"
            },
            {
              "label": "头痛失眠",
              "value": "7"
            },
            {
              "label": "视物模糊",
              "value": "8"
            },
            {
              "label": "皮肤瘙痒、皮疹",
              "value": "9"
            },
            {
              "label": "耳鸣、听力下降",
              "value": "10"
            },
            {
              "label": "其他",
              "value": "11"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "Symptomatic",
          "buttonName": null,
          "childrenKey": ["Symptom_Other"],
          "groupKeys": ["11"]
        }
      ],
      "append": null,
      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": "",
      "buttonName": null,
      "childrenKey": null,
      "groupKeys": []
    },
    {
      "label": "生活方式指导",
      "defaultValue": [],
      "span": 24,
      "key": "LifestyleAssessment",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "日吸烟量：平均",
          "defaultValue": null,
          "span": 24,
          "key": "Smoke",
          "type": "numberInput",
          "border": null,
          "disabledValue": null,
          "options": [],
          "children": null,
          "append": "支",
          "placeholder": "",
          "required": null,
          "show-limit": false,
          "parentKey": "LifestyleAssessment",
          "buttonName": null,
          "childrenKey": null
        },
        {
          "label": "日饮酒量：平均",
          "defaultValue": null,
          "span": 24,
          "key": "Drink",
          "type": "numberInput",
          "border": null,
          "disabledValue": null,
          "options": [],
          "children": null,
          "append": "两",
          "placeholder": "",
          "required": null,
          "show-limit": false,
          "parentKey": "LifestyleAssessment",
          "buttonName": null,
          "childrenKey": null
        }
      ],
      "append": null,
      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": "",
      "buttonName": null,
      "childrenKey": null,
      "groupKeys": []
    },
    {
      "label": "用药",
      "defaultValue": [],
      "span": 24,
      "key": "Medication",
      "type": "radio",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "化疗方案",
          "defaultValue": [],
          "span": 24,
          "key": "Chemotherapy",
          "type": "input",
          "border": false,
          "disabledValue": "1",
          "options": [],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "Medication",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": []
        },
        {
          "label": "用法",
          "defaultValue": [],
          "span": 24,
          "key": "Usage",
          "type": "radio",
          "border": false,
          "disabledValue": "1",
          "options": [
            {
              "label": "每日",
              "value": "1"
            },
            {
              "label": "间歇",
              "value": "2"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "Medication",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": null
        },
        {
          "label": "药品剂型",
          "defaultValue": [],
          "span": 24,
          "key": "Drug_Form",
          "type": "checkbox",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "固定剂量复合制剂",
              "value": "1"
            },
            {
              "label": "散装药",
              "value": "2"
            },
            {
              "label": "板式组合药",
              "value": "3"
            },
            {
              "label": "注射剂",
              "value": "4"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "Medication",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": null
        }
      ],
      "append": null,
      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": "",
      "buttonName": null,
      "childrenKey": null,
      "groupKeys": []
    },
    {
      "label": "不良反应",
      "defaultValue": [],
      "span": 24,
      "key": "AdverseReaction",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "药物不良反应",
          "defaultValue": [],
          "span": 24,
          "key": "Adverse",
          "type": "radioExtraDescription",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "无",
              "value": "1"
            },
            {
              "label": "有",
              "value": "2"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "AdverseReaction",
          "buttonName": null,
          "childrenKey": ["Adverse_Other"],
          "groupKeys": ["2"]
        },
        {
          "label": "并发症或合并症",
          "defaultValue": [],
          "span": 24,
          "key": "Complication",
          "type": "radioExtraDescription",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "无",
              "value": "1"
            },
            {
              "label": "有",
              "value": "2"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "AdverseReaction",
          "buttonName": null,
          "childrenKey": ["Complication_Other"],
          "groupKeys": ["2"]
        }
      ],
      "append": null,
      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": "",
      "buttonName": null,
      "childrenKey": null,
      "groupKeys": []
    },
    {
      "label": "转诊",
      "defaultValue": [],
      "span": 24,
      "key": "TransferHospital",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "科别",
          "defaultValue": [],
          "span": 24,
          "key": "Referral_Hospital",
          "type": "input",
          "border": false,
          "disabledValue": "0",
          "options": [],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "TransferHospital",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": null
        },
        {
          "label": "原因",
          "defaultValue": [],
          "span": 24,
          "key": "Referral_Reason",
          "type": "input",
          "border": false,
          "disabledValue": "0",
          "options": [],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "TransferHospital",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": null
        },
        {
          "label": "2周内随访，随访结果",
          "defaultValue": [],
          "span": 24,
          "key": "Visited_Result",
          "type": "input",
          "border": false,
          "disabledValue": "0",
          "options": [],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "TransferHospital",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": null
        },
        {
          "label": "处理意见",
          "defaultValue": [],
          "span": 24,
          "key": "Treatment_Suggestion",
          "type": "input",
          "border": false,
          "disabledValue": "0",
          "options": [],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "TransferHospital",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": null
        }
      ],
      "append": null,
      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": "",
      "buttonName": null,
      "childrenKey": null,
      "groupKeys": []
    },
    {
      "label": "处方",
      "defaultValue": null,
      "span": 24,
      "key": "Pre",
      "type": "title",
      "border": null,
      "disabledValue": null,
      "options": [],
      "children": [
        {
          "label": "处方",
          "defaultValue": null,
          "span": 24,
          "key": "Prescription",
          "type": "prescriptionType",
          "border": null,
          "disabledValue": null,
          "options": [],
          "children": null,
          "append": "",
          "placeholder": "",
          "required": null,
          "show-limit": false,
          "parentKey": "Pre",
          "buttonName": "TuberculosisPrescription",
          "childrenKey": null
        }
      ],
      "append": null,
      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": null,
      "buttonName": null,
      "childrenKey": null
    }
  ]
}