{
"id": 24312545326,
"form_name": "Medical History",
"created_date": "2013-09-27T19:33:35Z",
"patient": 1638401,
"topics": [
{
"topic": "Other",
"not_sure": false,
"total_score": null,
"questions": [
{
"question": "What is the reason for your visit?",
"answers": [
{
"response": "Need a new doctor",
"value": null,
"summary": "What is the reason for your visit? - Need a new doctor",
"score": null,
"image_url": null
}
]
}
]
},
{
"topic": "Smoking Status",
"not_sure": false,
"total_score": null,
"questions": [
{
"question": "Please select your smoking status.",
"answers": [
{
"response": "Never smoker",
"value": "4",
"summary": "Never smoker",
"score": null,
"image_url": null
}
]
}
]
},
{
"topic": "Caffeine Use",
"not_sure": true,
"total_score": null,
"questions": [
{
"question": "Briefly describe any caffeine use - e.g. how many cups of coffee a day?",
"answers": [
{
"response": "1 cup",
"value": null,
"summary": "Caffeine use: 1 cup a day",
"score": null,
"image_url": null
}
]
}
]
},
{
"topic": "Family History",
"not_sure": false,
"total_score": null,
"questions": [
{
"question": "Please list any medical conditions that members of your family (parents, grandparents, siblings) have had, and who had them.",
"answers": [
{
"response": "High cholesterol - Father",
"value": null,
"summary": "High cholesterol - Father",
"score": null,
"image_url": null
},
{
"response": "High blood pressure - Sister",
"value": null,
"summary": "High blood pressure - Sister",
"score": null,
"image_url": null
}
]
}
]
},
{
"topic": "Allergies",
"not_sure": false,
"total_score": null,
"questions": [
{
"question": "Please list any allergies to medications or food.",
"answers": [
{
"response": "penicillin = break into hives",
"value": null,
"summary": "penicillin = break into hives",
"score": null,
"image_url": null
},
{
"response": "prochlorperazine = seizures",
"value": null,
"summary": "prochlorperazine = seizures",
"score": null,
"image_url": null
}
]
}
]
},
{
"topic": "Colon Cancer Screening",
"not_sure": false,
"total_score": null,
"questions": [
{
"question": "When was your last colon cancer screening?",
"answers": [
{
"response": "1990 (negative)",
"value": null,
"summary": "Colon Cancer screening: 1990 (negative)",
"score": null,
"image_url": null
}
]
}
]
},
{
"topic": "Depression (PHQ-2)",
"not_sure": false,
"total_score": 1,
"questions": [
{
"question": "Little interest or pleasure in doing things in the last 2 weeks?",
"answers": [
{
"response": "Not at all",
"value": "LA6568-5",
"summary": null,
"score": 0,
"image_url": null
}
]
},
{
"question": "Feeling down, depressed, or hopeless in the last 2 weeks?",
"answers": [
{
"response": "Several Days",
"value": "LA6569-3",
"summary": null,
"score": 1,
"image_url": null
}
]
}
]
}
]
}
Patient Form Submissions
The Patient Form Submission Object
The Patient Form Submission Object represents a patient’s response to a patient form.
Submitted insurance card images and signatures are returned as AWS S3 presigned URLs. S3 presigned URLs are generated and grant a time-limited permission to download to the requestor for 24 hours.