2.2.0 - ci-build

VoiceaBiomarkerforAI - Local Development build (v2.2.0) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

Questionnaire: enrollmentformschema

Official URL: https://kind-lab.github.io/vbai-fhir/Questionnaire-enrollmentformschema Version: 2.2.0
Active as of 2024-05-29 Computable Name:
Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. Questionnairehttps://kind-lab.github.io/vbai-fhir/Questionnaire-enrollmentformschema#2.2.0
... ef_select_languageSelect a language: Select a language0..1choiceOptions: 3 options
Let's customize your experience: This application requires you to read text to answer questions. Do you have any vision-related requirements we can assist with?0..1choiceOptions: 2 options
... ef_vision_a11y_optionsYes, I would like to use some of the accessibility features of the app0..1stringEnable When: ef_any_vision_related_req = '1'
This application may present some sound files for you to listen to. Do you have any hearing-related requirements we can assist with?0..1choiceOptions: 2 options
... ef_hearing_a11y_optionsYes, I would like to use some of the accessibility features of the app0..1stringEnable When: ef_any_hearing_related_req = '1'
... ef_any_physical_challengesThis application requires you to navigate through the questions using a touch screen. Do you have any physical challenges we can accomodate?0..1choiceOptions: 2 options
... ef_physical_a11y_optionsYes, I would like to use some of the accessibility features of the app0..1stringEnable When: ef_any_physical_challenges = '1'
... ef_any_cognitive_challegesThis application requires you to read text, answer questions, and follow directions. Do you have any cognitive challenges, including difficulty reading, that we can assist with?0..1choiceOptions: 2 options
... ef_cognitive_a11y_optionsYes, I would like to use some of the accessibility features of the app0..1stringEnable When: ef_any_cognitive_challeges = '1'
... ef_completed_byWho is participating in completing this survey?: Check all that apply0..1string
... ef_primary_languageTell us about yourself: What is your primary language?0..1choiceOptions: 4 options
... ef_primary_language_otherIf primary language is "other", please specify:0..1stringEnable When: ef_primary_language = '4'
... ef_fluent_languagesDo you speak any additional language(s) fluently (similar to a native speaker)?0..1string
... ef_fluent_language_otherIf you speak any other languages fluently, please specify:0..1stringEnable When: ef_fluent_languages = 5
... ef_dobWhat is your date of birth?0..1string
... ef_laryng_cancerDo you have any of these conditions, diagnosed by a clinician? (Check all that apply if you currently have the condition)Voice Disorders: Laryngeal cancer0..1choiceOptions: 2 options
... ef_benign_cord_lesionLesions of the vocal cord (nodule, polyp, cyst)0..1choiceOptions: 2 options
... ef_rrpRecurrent laryngeal papilloma (RRP)0..1choiceOptions: 2 options
... ef_spas_dysSpasmodic dysphonia / Laryngeal Tremor0..1choiceOptions: 2 options
... ef_voc_fold_paralysisVocal fold paralysis0..1choiceOptions: 2 options
... ef_alz_dementia_mciNeurological and Neurodegenerative Disorders: Alzheimer's, dementia, or mild cognitive impairment0..1choiceOptions: 2 options
... ef_alsAmyotrophic Lateral Sclerosis (ALS)0..1choiceOptions: 2 options
... ef_parkinsonsParkinson's disease0..1choiceOptions: 2 options
... ef_alcohol_subst_abuseMood and Psychiatric Disorders: Alcohol or Substance Use Disorder0..1choiceOptions: 2 options
... ef_gadAnxiety disorder0..1choiceOptions: 2 options
... ef_add_adhdAttention-Deficit / Hyperactivity Disorder (ADHD)0..1choiceOptions: 2 options
... ef_asdAutism Spectrum Disorder (ASD)0..1choiceOptions: 2 options
... ef_bipolarBipolar Disorder0..1choiceOptions: 2 options
... ef_bpdBorderline Personality Disorder (BPD)0..1choiceOptions: 2 options
... ef_depressionDepression or Major Depressive Disorder0..1choiceOptions: 2 options
... ef_edEating Disorder (ED)0..1choiceOptions: 2 options
... ef_insomniaInsomnia / sleep disorder0..1choiceOptions: 2 options
... ef_ocdObsessive-Compulsive Disorder (OCD)0..1choiceOptions: 2 options
... ef_panicPanic Disorder0..1choiceOptions: 2 options
... ef_ptsdPost-Traumatic Stress Disorder (PTSD)0..1choiceOptions: 2 options
... ef_schizophreniaSchizophrenia0..1choiceOptions: 2 options
... ef_soc_anx_disSocial Anxiety Disorder0..1choiceOptions: 2 options
... ef_other_psychOther psychiatric disorder0..1choiceOptions: 2 options
... ef_asthmaRespiratory disorders: Asthma0..1choiceOptions: 2 options
... ef_airway_stenosisAirway stenosis (for example: subglottic stenosis; laryngeal stenosis)0..1choiceOptions: 2 options
... ef_chronic_coughChronic Cough0..1choiceOptions: 2 options
... ef_copdCOPD0..1choiceOptions: 2 options
... ef_osaObstructive Sleep Apnea (OSA)0..1choiceOptions: 2 options
... ef_autismPediatric disorders: Autism Spectrum Disorder (ASD)0..1choiceOptions: 2 options
... ef_speech_delaySpeech Delay0..1choiceOptions: 2 options
... ef_eligible_studiesEligible Studies: Eligible Studies0..1string
... ef_learn_about_this_studyHow did you learn about this study?: How did you learn about this study?0..1choiceOptions: 6 options
... ef_learn_about_this_study_eventIf "At an event", please specify:0..1stringEnable When: ef_learn_about_this_study = 'event'
... ef_learn_about_this_study_otherIf "Other", please specify:0..1stringEnable When: ef_learn_about_this_study = 'other'
... ef_first_nameContact Information: First Name0..1string
... ef_last_nameLast Name0..1string
... ef_phone_numberPhone Number0..1string
... ef_emailEmail0..1string
... ef_contact_info_storedI want my contact information to be kept in a repository for this study which can be used to contact me to ask me to enroll in further studies or return important results. My information will not be shared with third parties.0..1choiceOptions: 2 options
... ef_enrollmentReview and Enroll:: Please review your answers reading all the way through the bottom and select an option.If you have any questions, you can still proceed with enrollment and ask or make changes at a later time.0..1choiceOptions: 2 options
... ef_is_control_participantIs Control Participant?0..1choiceOptions: 2 options
... ef_reason_decline_enrollPlease select a reason for declining0..1choiceEnable When: ef_enrollment = 'Decline'
Options: 5 options
... ef_other_reason_declineIf "Other" reason for declining enrollment, please specify:0..1stringEnable When: ef_reason_decline_enroll = '5'
... ef_enrollment_institutionEnrollment Institution0..1choiceOptions: 6 options
... ef_researcher_emailResearcher Email0..1string
... ef_enrollment_originEnrollment Origin0..1choiceOptions: 2 options
... ef_started_atEnrollment Form - Metadata: Enrollment Form Started At0..1string
... ef_completed_atEnrollment Form Completed At0..1string
... ef_durationEnrollment Form Duration (seconds)0..1string

doco Documentation for this format

Options Sets

Answer options for ef_select_language

  • English
  • Español
  • Français

Answer options for ef_any_vision_related_req

  • Yes
  • No

Answer options for ef_any_hearing_related_req

  • Yes
  • No

Answer options for ef_any_physical_challenges

  • Yes
  • No

Answer options for ef_any_cognitive_challeges

  • Yes
  • No

Answer options for ef_primary_language

  • English
  • French
  • Spanish
  • Other (Please specify below)

Answer options for ef_laryng_cancer

  • Unchecked
  • Checked

Answer options for ef_benign_cord_lesion

  • Unchecked
  • Checked

Answer options for ef_rrp

  • Unchecked
  • Checked

Answer options for ef_spas_dys

  • Unchecked
  • Checked

Answer options for ef_voc_fold_paralysis

  • Unchecked
  • Checked

Answer options for ef_alz_dementia_mci

  • Unchecked
  • Checked

Answer options for ef_als

  • Unchecked
  • Checked

Answer options for ef_parkinsons

  • Unchecked
  • Checked

Answer options for ef_alcohol_subst_abuse

  • Unchecked
  • Checked

Answer options for ef_gad

  • Unchecked
  • Checked

Answer options for ef_add_adhd

  • Unchecked
  • Checked

Answer options for ef_asd

  • Unchecked
  • Checked

Answer options for ef_bipolar

  • Unchecked
  • Checked

Answer options for ef_bpd

  • Unchecked
  • Checked

Answer options for ef_depression

  • Unchecked
  • Checked

Answer options for ef_ed

  • Unchecked
  • Checked

Answer options for ef_insomnia

  • Unchecked
  • Checked

Answer options for ef_ocd

  • Unchecked
  • Checked

Answer options for ef_panic

  • Unchecked
  • Checked

Answer options for ef_ptsd

  • Unchecked
  • Checked

Answer options for ef_schizophrenia

  • Unchecked
  • Checked

Answer options for ef_soc_anx_dis

  • Unchecked
  • Checked

Answer options for ef_other_psych

  • Unchecked
  • Checked

Answer options for ef_asthma

  • Unchecked
  • Checked

Answer options for ef_airway_stenosis

  • Unchecked
  • Checked

Answer options for ef_chronic_cough

  • Unchecked
  • Checked

Answer options for ef_copd

  • Unchecked
  • Checked

Answer options for ef_osa

  • Unchecked
  • Checked

Answer options for ef_autism

  • Unchecked
  • Checked

Answer options for ef_speech_delay

  • Unchecked
  • Checked

Answer options for ef_learn_about_this_study

  • Through my physician/provider
  • A flyer
  • Social Media
  • Bridge2AI Website
  • At an event
  • Other

Answer options for ef_contact_info_stored

  • Yes
  • No

Answer options for ef_enrollment

  • Enroll
  • Decline

Answer options for ef_is_control_participant

  • Yes
  • No

Answer options for ef_reason_decline_enroll

  • I am not interested in having my voice recorded
  • I do not have enough time today and want to be contacted later
  • I do not have enough time and do not want to be contacted later
  • I prefer not to share any health information for research
  • Other (Please specify)

Answer options for ef_enrollment_institution

  • BCH
  • MIT
  • Mt. Sinai
  • USF
  • VUMC
  • WCM

Answer options for ef_enrollment_origin

  • Bridge2AI App
  • Bridge2AI Enrollment Website