Structure LinkID Text Cardinality Type Description & Constraints Questionnaire https://kind-lab.github.io/vbai-fhir/Questionnaire-enrollmentformschema#2.2.0 ef_select_language Select a language: Select a language 0..1 choice Options: 3 options ef_any_vision_related_req 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..1 choice Options: 2 options ef_vision_a11y_options Yes, I would like to use some of the accessibility features of the app 0..1 string Enable When: ef_any_vision_related_req = '1' ef_any_hearing_related_req This application may present some sound files for you to listen to. Do you have any hearing-related requirements we can assist with? 0..1 choice Options: 2 options ef_hearing_a11y_options Yes, I would like to use some of the accessibility features of the app 0..1 string Enable When: ef_any_hearing_related_req = '1' ef_any_physical_challenges This application requires you to navigate through the questions using a touch screen. Do you have any physical challenges we can accomodate? 0..1 choice Options: 2 options ef_physical_a11y_options Yes, I would like to use some of the accessibility features of the app 0..1 string Enable When: ef_any_physical_challenges = '1' ef_any_cognitive_challeges This 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..1 choice Options: 2 options ef_cognitive_a11y_options Yes, I would like to use some of the accessibility features of the app 0..1 string Enable When: ef_any_cognitive_challeges = '1' ef_completed_by Who is participating in completing this survey?: Check all that apply 0..1 string ef_primary_language Tell us about yourself: What is your primary language? 0..1 choice Options: 4 options ef_primary_language_other If primary language is "other", please specify: 0..1 string Enable When: ef_primary_language = '4' ef_fluent_languages Do you speak any additional language(s) fluently (similar to a native speaker)? 0..1 string ef_fluent_language_other If you speak any other languages fluently, please specify: 0..1 string Enable When: ef_fluent_languages = 5 ef_dob What is your date of birth? 0..1 string ef_laryng_cancer Do you have any of these conditions, diagnosed by a clinician? (Check all that apply if you currently have the condition)Voice Disorders: Laryngeal cancer 0..1 choice Options: 2 options ef_benign_cord_lesion Lesions of the vocal cord (nodule, polyp, cyst) 0..1 choice Options: 2 options ef_rrp Recurrent laryngeal papilloma (RRP) 0..1 choice Options: 2 options ef_spas_dys Spasmodic dysphonia / Laryngeal Tremor 0..1 choice Options: 2 options ef_voc_fold_paralysis Vocal fold paralysis 0..1 choice Options: 2 options ef_alz_dementia_mci Neurological and Neurodegenerative Disorders: Alzheimer's, dementia, or mild cognitive impairment 0..1 choice Options: 2 options ef_als Amyotrophic Lateral Sclerosis (ALS) 0..1 choice Options: 2 options ef_parkinsons Parkinson's disease 0..1 choice Options: 2 options ef_alcohol_subst_abuse Mood and Psychiatric Disorders: Alcohol or Substance Use Disorder 0..1 choice Options: 2 options ef_gad Anxiety disorder 0..1 choice Options: 2 options ef_add_adhd Attention-Deficit / Hyperactivity Disorder (ADHD) 0..1 choice Options: 2 options ef_asd Autism Spectrum Disorder (ASD) 0..1 choice Options: 2 options ef_bipolar Bipolar Disorder 0..1 choice Options: 2 options ef_bpd Borderline Personality Disorder (BPD) 0..1 choice Options: 2 options ef_depression Depression or Major Depressive Disorder 0..1 choice Options: 2 options ef_ed Eating Disorder (ED) 0..1 choice Options: 2 options ef_insomnia Insomnia / sleep disorder 0..1 choice Options: 2 options ef_ocd Obsessive-Compulsive Disorder (OCD) 0..1 choice Options: 2 options ef_panic Panic Disorder 0..1 choice Options: 2 options ef_ptsd Post-Traumatic Stress Disorder (PTSD) 0..1 choice Options: 2 options ef_schizophrenia Schizophrenia 0..1 choice Options: 2 options ef_soc_anx_dis Social Anxiety Disorder 0..1 choice Options: 2 options ef_other_psych Other psychiatric disorder 0..1 choice Options: 2 options ef_asthma Respiratory disorders: Asthma 0..1 choice Options: 2 options ef_airway_stenosis Airway stenosis (for example: subglottic stenosis; laryngeal stenosis) 0..1 choice Options: 2 options ef_chronic_cough Chronic Cough 0..1 choice Options: 2 options ef_copd COPD 0..1 choice Options: 2 options ef_osa Obstructive Sleep Apnea (OSA) 0..1 choice Options: 2 options ef_autism Pediatric disorders: Autism Spectrum Disorder (ASD) 0..1 choice Options: 2 options ef_speech_delay Speech Delay 0..1 choice Options: 2 options ef_eligible_studies Eligible Studies: Eligible Studies 0..1 string ef_learn_about_this_study How did you learn about this study?: How did you learn about this study? 0..1 choice Options: 6 options ef_learn_about_this_study_event If "At an event", please specify: 0..1 string Enable When: ef_learn_about_this_study = 'event' ef_learn_about_this_study_other If "Other", please specify: 0..1 string Enable When: ef_learn_about_this_study = 'other' ef_first_name Contact Information: First Name 0..1 string ef_last_name Last Name 0..1 string ef_phone_number Phone Number 0..1 string ef_email Email 0..1 string ef_contact_info_stored I 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..1 choice Options: 2 options ef_enrollment Review 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..1 choice Options: 2 options ef_is_control_participant Is Control Participant? 0..1 choice Options: 2 options ef_reason_decline_enroll Please select a reason for declining 0..1 choice Enable When: ef_enrollment = 'Decline' Options: 5 options ef_other_reason_decline If "Other" reason for declining enrollment, please specify: 0..1 string Enable When: ef_reason_decline_enroll = '5' ef_enrollment_institution Enrollment Institution 0..1 choice Options: 6 options ef_researcher_email Researcher Email 0..1 string ef_enrollment_origin Enrollment Origin 0..1 choice Options: 2 options ef_started_at Enrollment Form - Metadata: Enrollment Form Started At 0..1 string ef_completed_at Enrollment Form Completed At 0..1 string ef_duration Enrollment Form Duration (seconds) 0..1 string 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
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?
Yes, I would like to use some of the accessibility features of the app
This application may present some sound files for you to listen to. Do you have any hearing-related requirements we can assist with?
This application requires you to navigate through the questions using a touch screen. Do you have any physical challenges we can accomodate?
This 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?
Who is participating in completing this survey?: Check all that apply
Tell us about yourself: What is your primary language?
If primary language is "other", please specify:
Do you speak any additional language(s) fluently (similar to a native speaker)?
If you speak any other languages fluently, please specify:
Do you have any of these conditions, diagnosed by a clinician? (Check all that apply if you currently have the condition)Voice Disorders: Laryngeal cancer
Lesions of the vocal cord (nodule, polyp, cyst)
Neurological and Neurodegenerative Disorders: Alzheimer's, dementia, or mild cognitive impairment
Mood and Psychiatric Disorders: Alcohol or Substance Use Disorder
Attention-Deficit / Hyperactivity Disorder (ADHD)
Airway stenosis (for example: subglottic stenosis; laryngeal stenosis)
Pediatric disorders: Autism Spectrum Disorder (ASD)
How did you learn about this study?: How did you learn about this study?
I 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.
Review 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.
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
If "Other" reason for declining enrollment, please specify:
Enrollment Form - Metadata: Enrollment Form Started At