docs/Templates/FollowUpTuberculosisFirstRecord.json

{
  "Key": "FollowUpTuberculosisFirstRecord",
  "Name": "肺结核患者第一次入户随访记录表",
  "Content": [
    {
      "label": "基本信息",
      "defaultValue": [],
      "span": 12,
      "key": "BasicInfo",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "患者类型",
          "defaultValue": [],
          "span": 24,
          "key": "Patients_Type",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "初治",
              "value": "1"
            },
            {
              "label": "复治",
              "value": "2"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "BasicInfo",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": []
        },
        {
          "label": "痰菌情况",
          "defaultValue": [],
          "span": 24,
          "key": "Sputum",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "阳性",
              "value": "1"
            },
            {
              "label": "阴性",
              "value": "2"
            },
            {
              "label": "未查痰",
              "value": "3"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "BasicInfo",
          "buttonName": null,
          "childrenKey": null,
          "groupKeys": []
        },
        {
          "label": "耐药情况",
          "defaultValue": [],
          "span": 24,
          "key": "Drug_Fast",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "耐药",
              "value": "1"
            },
            {
              "label": "非耐药",
              "value": "2"
            },
            {
              "label": "未检测",
              "value": "3"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
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          "buttonName": null,
          "childrenKey": null,
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      ],
      "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": "头痛失眠",
              "value": "6"
            },
            {
              "label": "视物模糊",
              "value": "7"
            },
            {
              "label": "皮肤瘙痒、皮疹",
              "value": "8"
            },
            {
              "label": "耳鸣、听力下降",
              "value": "9"
            },
            {
              "label": "其他",
              "value": "10"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "Symptomatic",
          "buttonName": null,
          "childrenKey": ["Symptom_Other"],
          "groupKeys": ["10"]
        }
      ],
      "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
        },
        {
          "label": "督导人员选择",
          "defaultValue": [],
          "span": 24,
          "key": "Supervisor",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "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": "家庭居住环境评估",
      "defaultValue": [],
      "span": 24,
      "key": "HomeLivingEnvironmentAssessment",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "单独的居室",
          "defaultValue": [],
          "span": 24,
          "key": "Bedroom",
          "type": "radio",
          "border": false,
          "disabledValue": "1",
          "options": [
            {
              "label": "有",
              "value": "1"
            },
            {
              "label": "无",
              "value": "2"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "HomeLivingEnvironmentAssessment",
          "buttonName": null,
          "childrenKey": [],
          "groupKeys": []
        },
        {
          "label": "通风情况",
          "defaultValue": [],
          "span": 24,
          "key": "Ventilate",
          "type": "radio",
          "border": false,
          "disabledValue": "1",
          "options": [
            {
              "label": "良好",
              "value": "1"
            },
            {
              "label": "一般",
              "value": "2"
            },
            {
              "label": "差",
              "value": "3"
            }
          ],
          "children": null,
          "append": null,
          "placeholder": null,
          "required": null,
          "show-limit": null,
          "parentKey": "HomeLivingEnvironmentAssessment",
          "buttonName": null,
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      "show-limit": null,
      "parentKey": "",
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      "childrenKey": null,
      "groupKeys": []
    },
    {
      "label": "生活方式评估",
      "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
        }
      ],
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      "placeholder": null,
      "required": null,
      "show-limit": null,
      "parentKey": "",
      "buttonName": null,
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      "groupKeys": []
    },
    {
      "label": "健康教育及培训",
      "defaultValue": [],
      "span": 24,
      "key": "HealthEducationAndTraining",
      "type": "input",
      "border": false,
      "disabledValue": "1",
      "options": [],
      "children": [
        {
          "label": "取药地点",
          "defaultValue": [],
          "span": 24,
          "key": "Get_Drug_Site",
          "type": "input",
          "border": false,
          "disabledValue": "1",
          "options": [],
          "children": null,
          "append": null,
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          "buttonName": null,
          "childrenKey": [],
          "groupKeys": []
        },
        {
          "label": "取药时间",
          "defaultValue": [],
          "span": 24,
          "key": "Get_Drug_Time",
          "type": "date",
          "border": false,
          "disabledValue": "1",
          "options": [],
          "children": null,
          "append": null,
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          "show-limit": null,
          "parentKey": "HealthEducationAndTraining",
          "buttonName": null,
          "childrenKey": [],
          "groupKeys": []
        },
        {
          "label": "服药记录卡的填写",
          "defaultValue": [],
          "span": 24,
          "key": "Drug_Card",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "掌握",
              "value": "1"
            },
            {
              "label": "未掌握",
              "value": "2"
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        {
          "label": "服药方法及药品存放",
          "defaultValue": [],
          "span": 24,
          "key": "Drug_Method",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "掌握",
              "value": "1"
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              "label": "未掌握",
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          "parentKey": "HealthEducationAndTraining",
          "buttonName": null,
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        },
        {
          "label": "肺结核治疗疗程",
          "defaultValue": [],
          "span": 24,
          "key": "Main_Course_Daily",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "掌握",
              "value": "1"
            },
            {
              "label": "未掌握",
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        {
          "label": "不规律服药危害",
          "defaultValue": [],
          "span": 24,
          "key": "Indiscipline_Drug",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "掌握",
              "value": "1"
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              "label": "未掌握",
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          "groupKeys": []
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        {
          "label": "服药后不良反应及处理",
          "defaultValue": [],
          "span": 24,
          "key": "Untoward_Effect",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "掌握",
              "value": "1"
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              "label": "未掌握",
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        },
        {
          "label": "治疗期间复诊查痰",
          "defaultValue": [],
          "span": 24,
          "key": "Reexamination",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
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              "label": "掌握",
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              "label": "未掌握",
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        {
          "label": "外出期间如何坚持服药",
          "defaultValue": [],
          "span": 24,
          "key": "Outing_Drug",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
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              "label": "掌握",
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              "label": "未掌握",
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        },
        {
          "label": "生活习惯及注意事项",
          "defaultValue": [],
          "span": 24,
          "key": "Living_Habit",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "掌握",
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              "label": "未掌握",
              "value": "2"
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        },
        {
          "label": "密切接触者检查",
          "defaultValue": [],
          "span": 24,
          "key": "Contact",
          "type": "radio",
          "border": false,
          "disabledValue": "0",
          "options": [
            {
              "label": "掌握",
              "value": "1"
            },
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              "label": "未掌握",
              "value": "2"
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}