POST v1/api/GetPreScreen?caseId={caseId}
Retrieve Prescreen questions
Request Information
URI Parameters
| Name | Description | Type | Additional information |
|---|---|---|---|
| caseId |
(optional - but recommended) a unique identifier to both group calls, and to tie a Case to an Agency. |
string |
None. |
Body Parameters
GetPreScreenRequestDto
GetPreScreenRequestDto| Name | Description | Type | Additional information |
|---|---|---|---|
| RulebaseId | string |
None. |
Request Formats
application/json
Sample:
REQUEST
{
"GET REQUEST": "NO INPUT"
}
Response Information
Resource Description
GetPreScreenResponseDto
GetPrescreenResponseDto| Name | Description | Type | Additional information |
|---|---|---|---|
| Questions | Collection of QuestionDto |
None. |
Response Formats
application/json
Sample:
RESPONSE
[
{
"$id": "1",
"QuestionId": "BirthDate",
"Text": "Date of birth",
"Type": "date",
"AllowNull": true,
"Options": {}
},
{
"$id": "2",
"QuestionId": "Height",
"Text": "Height (feet/in)",
"Type": "single-select",
"AllowNull": true,
"Options": {
"4-8-or-less": {
"$id": "3",
"Label": "4' 8\" or less",
"SubQuestions": []
},
"4-9": {
"$id": "4",
"Label": "4' 9\"",
"SubQuestions": []
},
"4-10": {
"$id": "5",
"Label": "4' 10\"",
"SubQuestions": []
},
"4-11": {
"$id": "6",
"Label": "4' 11\"",
"SubQuestions": []
},
"5-0": {
"$id": "7",
"Label": "5' 0\"",
"SubQuestions": []
},
"5-1": {
"$id": "8",
"Label": "5' 1\"",
"SubQuestions": []
},
"5-2": {
"$id": "9",
"Label": "5' 2\"",
"SubQuestions": []
},
"5-3": {
"$id": "10",
"Label": "5' 3\"",
"SubQuestions": []
},
"5-4": {
"$id": "11",
"Label": "5' 4\"",
"SubQuestions": []
},
"5-5": {
"$id": "12",
"Label": "5' 5\"",
"SubQuestions": []
},
"5-6": {
"$id": "13",
"Label": "5' 6\"",
"SubQuestions": []
},
"5-7": {
"$id": "14",
"Label": "5' 7\"",
"SubQuestions": []
},
"5-8": {
"$id": "15",
"Label": "5' 8\"",
"SubQuestions": []
},
"5-9": {
"$id": "16",
"Label": "5' 9\"",
"SubQuestions": []
},
"5-10": {
"$id": "17",
"Label": "5' 10\"",
"SubQuestions": []
},
"5-11": {
"$id": "18",
"Label": "5' 11\"",
"SubQuestions": []
},
"6-0": {
"$id": "19",
"Label": "6' 0\"",
"SubQuestions": []
},
"6-1": {
"$id": "20",
"Label": "6' 1\"",
"SubQuestions": []
},
"6-2": {
"$id": "21",
"Label": "6' 2\"",
"SubQuestions": []
},
"6-3": {
"$id": "22",
"Label": "6' 3\"",
"SubQuestions": []
},
"6-4": {
"$id": "23",
"Label": "6' 4\"",
"SubQuestions": []
},
"6-5": {
"$id": "24",
"Label": "6' 5\"",
"SubQuestions": []
},
"6-6": {
"$id": "25",
"Label": "6' 6\"",
"SubQuestions": []
},
"6-7": {
"$id": "26",
"Label": "6' 7\"",
"SubQuestions": []
},
"6-8": {
"$id": "27",
"Label": "6' 8\"",
"SubQuestions": []
},
"6-9": {
"$id": "28",
"Label": "6' 9\"",
"SubQuestions": []
},
"6-10": {
"$id": "29",
"Label": "6' 10\"",
"SubQuestions": []
},
"6-11-or-more": {
"$id": "30",
"Label": "6' 11\" or more",
"SubQuestions": []
}
}
},
{
"$id": "31",
"QuestionId": "Weight",
"Text": "Weight (lbs)",
"Type": "number",
"AllowNull": true,
"Options": {}
},
{
"$id": "32",
"QuestionId": "TobaccoUse",
"Text": "Have you ever used any form of tobacco or any other nicotine product or by-product?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "33",
"Label": "Yes",
"SubQuestions": [
{
"$id": "34",
"QuestionId": "TobaccoUseDateLastUsed",
"Text": "Date last used",
"Type": "date-month",
"AllowNull": true,
"Options": {}
},
{
"$id": "35",
"QuestionId": "TobaccoUseProductType",
"Text": "Product type",
"Type": "single-select",
"AllowNull": true,
"Options": {
"cigarettes": {
"$id": "36",
"Label": "Cigarettes",
"SubQuestions": []
},
"cigars": {
"$id": "37",
"Label": "Cigars",
"SubQuestions": [
{
"$id": "38",
"QuestionId": "TobaccoUseProductTypeCigarsFrequency",
"Text": "Amount used per month",
"Type": "single-select",
"AllowNull": false,
"Options": {
"0-2": {
"$id": "39",
"Label": "0-2",
"SubQuestions": []
},
"more-than-2": {
"$id": "40",
"Label": "More than 2",
"SubQuestions": []
}
}
}
]
},
"pipe-tobacco": {
"$id": "41",
"Label": "Pipe Tobacco",
"SubQuestions": []
},
"chewing-tobacco": {
"$id": "42",
"Label": "Chewing Tobacco",
"SubQuestions": []
},
"other": {
"$id": "43",
"Label": "Other",
"SubQuestions": []
}
}
},
{
"$id": "44",
"QuestionId": "TobaccoUseLengthOfUse",
"Text": "How long used (~yrs)",
"Type": "single-select",
"AllowNull": true,
"Options": {
"1-2-years": {
"$id": "45",
"Label": "1-2 years",
"SubQuestions": []
},
"3-5-years": {
"$id": "46",
"Label": "3-5 years",
"SubQuestions": []
},
"6-10-years": {
"$id": "47",
"Label": "6-10 years",
"SubQuestions": []
},
"greater-than-10-years": {
"$id": "48",
"Label": "Greater than 10 years",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "49",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "50",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "51",
"QuestionId": "ConditionHistory",
"Text": "Has a licensed medical professional diagnosed you with any of the following conditions: Cancer, Diabetes, Drug or Alcohol Abuse, Cardiovascular Disease, Cirrhosis, Sleep Apnea, Asthma, Emphysema, Anxiety, Panic Attacks / Obsessive Compulsive Disorder, or other Mental Health Issues?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "52",
"Label": "Yes",
"SubQuestions": [
{
"$id": "53",
"QuestionId": "ConditionHistoryCancer",
"Text": "Cancer",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "54",
"Label": "Yes",
"SubQuestions": [
{
"$id": "55",
"QuestionId": "ConditionHistoryCancerType",
"Text": "If 'Yes' to cancer, type?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "56",
"QuestionId": "ConditionHistoryCancerTreatment",
"Text": "Treatment",
"Type": "text",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "57",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "58",
"QuestionId": "ConditionHistoryDiabetes",
"Text": "Diabetes",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "59",
"Label": "Yes",
"SubQuestions": [
{
"$id": "60",
"QuestionId": "ConditionHistoryDiabetesDiagnosisDate",
"Text": "If 'Yes' to diabetes, when first diagnosed?",
"Type": "date-month",
"AllowNull": false,
"Options": {}
},
{
"$id": "61",
"QuestionId": "ConditionHistoryDiabetesTreatment",
"Text": "What type of treatment do you use?",
"Type": "single-select",
"AllowNull": false,
"Options": {
"diet": {
"$id": "62",
"Label": "Diet",
"SubQuestions": []
},
"oral-medication": {
"$id": "63",
"Label": "Oral Medication",
"SubQuestions": []
},
"insulin": {
"$id": "64",
"Label": "Insulin",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "65",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "66",
"QuestionId": "ConditionHistoryDrugAbuse",
"Text": "Drug Abuse",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "67",
"Label": "Yes",
"SubQuestions": [
{
"$id": "68",
"QuestionId": "ConditionHistoryDrugAbuseDrugs",
"Text": "If 'Yes' to Drug Abuse, what kind of drugs have you used?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "69",
"QuestionId": "ConditionHistoryDrugAbuseLastUsed",
"Text": "What was the date you last used drugs?",
"Type": "date-month",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "70",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "71",
"QuestionId": "ConditionHistoryAlcoholAbuse",
"Text": "Alcohol Abuse",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "72",
"Label": "Yes",
"SubQuestions": [
{
"$id": "73",
"QuestionId": "ConditionHistoryAlcoholAbuseQuantity",
"Text": "If 'Yes' to Alcohol Abuse, how much and how often do you consume alcohol?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "74",
"QuestionId": "ConditionHistoryAlcoholAbuseLastDrink",
"Text": "What was the date of your last drink?",
"Type": "date-month",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "75",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "76",
"QuestionId": "ConditionHistoryCardioVascularDisease",
"Text": "Cardiovascular Disease",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "77",
"Label": "Yes",
"SubQuestions": [
{
"$id": "78",
"QuestionId": "ConditionHistoryCardioVascularDiseaseWhen",
"Text": "If 'Yes' to Cardiovascular Disease, when were you first diagnosed?",
"Type": "date",
"AllowNull": false,
"Options": {}
},
{
"$id": "79",
"QuestionId": "ConditionHistoryCardioVascularDiseaseSurgery",
"Text": "Have you had any surgery?",
"Type": "boolean",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "80",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "81",
"QuestionId": "ConditionHistoryCirrhosis",
"Text": "Cirrhosis",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "82",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "83",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "84",
"QuestionId": "ConditionHistorySleepApnea",
"Text": "Sleep Apnea",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "85",
"Label": "Yes",
"SubQuestions": [
{
"$id": "86",
"QuestionId": "ConditionHistorySleepApneaTreatment",
"Text": "If 'Yes' to Sleep Apnea, any treatment?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "87",
"QuestionId": "ConditionHistorySleepApneaHowLong",
"Text": "How Long?",
"Type": "text",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "88",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "89",
"QuestionId": "ConditionHistoryAsthma",
"Text": "Asthma",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "90",
"Label": "Yes",
"SubQuestions": [
{
"$id": "91",
"QuestionId": "ConditionHistoryAsthmaMostRecentAttack",
"Text": "If 'Yes' to Asthma, date of most recent attack?",
"Type": "date-month",
"AllowNull": false,
"Options": {}
},
{
"$id": "92",
"QuestionId": "ConditionHistoryAsthmaSeverity",
"Text": "Do you consider your case to be (choose one) Mild, Moderate, Severe?",
"Type": "single-select",
"AllowNull": false,
"Options": {
"mild": {
"$id": "93",
"Label": "Mild",
"SubQuestions": []
},
"moderate": {
"$id": "94",
"Label": "Moderate",
"SubQuestions": []
},
"severe": {
"$id": "95",
"Label": "Severe",
"SubQuestions": []
}
}
},
{
"$id": "96",
"QuestionId": "ConditionHistoryAsthmaPrednisone",
"Text": " Has prednisone ever been prescribed?",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "97",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "98",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "99",
"QuestionId": "ConditionHistoryAsthmaHospitalized",
"Text": "Have you ever been hospitalized for asthma?",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "100",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "101",
"Label": "No",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "102",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "103",
"QuestionId": "ConditionHistoryEmphysema",
"Text": "Emphysema",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "104",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "105",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "106",
"QuestionId": "ConditionHistoryAnxiety",
"Text": "Anxiety",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "107",
"Label": "Yes",
"SubQuestions": [
{
"$id": "108",
"QuestionId": "ConditionHistoryAnxietyType",
"Text": "If 'Yes' to Anxiety, type?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "109",
"QuestionId": "ConditionHistoryAnxietyTreatment",
"Text": "Treatment",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "110",
"QuestionId": "ConditionHistoryAnxietySeverity",
"Text": "Do you consider your case to be (choose one) Mild, Moderate, Severe?",
"Type": "single-select",
"AllowNull": false,
"Options": {
"mild": {
"$id": "111",
"Label": "Mild",
"SubQuestions": []
},
"moderate": {
"$id": "112",
"Label": "Moderate",
"SubQuestions": []
},
"severe": {
"$id": "113",
"Label": "Severe",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "114",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "115",
"QuestionId": "ConditionHistoryPanicAttacks",
"Text": "Panic Attacks / OCD",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "116",
"Label": "Yes",
"SubQuestions": [
{
"$id": "117",
"QuestionId": "ConditionHistoryPanicAttacksSeverity",
"Text": "Do you consider your case to be (choose one) Mild, Moderate, Severe?",
"Type": "single-select",
"AllowNull": false,
"Options": {
"mild": {
"$id": "118",
"Label": "Mild",
"SubQuestions": []
},
"moderate": {
"$id": "119",
"Label": "Moderate",
"SubQuestions": []
},
"severe": {
"$id": "120",
"Label": "Severe",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "121",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "122",
"QuestionId": "ConditionHistoryDepression",
"Text": "Depression",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "123",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "124",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "125",
"QuestionId": "ConditionHistoryOther",
"Text": "Other",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "126",
"Label": "Yes",
"SubQuestions": [
{
"$id": "127",
"QuestionId": "ConditionHistoryOtherExplanation",
"Text": "If 'Yes' to Other, please explain",
"Type": "text",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "128",
"Label": "No",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "129",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "130",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "131",
"QuestionId": "FamilyHistory",
"Text": " Has there been any indication or death of cancer (skin, prostate, other), or cardiovascular disease (heart attack, stroke, other) in your natural parents or siblings prior to their attaining age 60?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "132",
"Label": "Yes",
"SubQuestions": [
{
"$id": "133",
"QuestionId": "FamilyHistoryIndication",
"Text": "If 'Yes' to indication",
"Type": "multi-select",
"AllowNull": false,
"Options": {
"siblings": {
"$id": "134",
"Label": "Sibling(s)",
"SubQuestions": []
},
"1-parent": {
"$id": "135",
"Label": "1 Parent",
"SubQuestions": []
},
"2-parent": {
"$id": "136",
"Label": "2 Parents",
"SubQuestions": []
}
}
},
{
"$id": "137",
"QuestionId": "FamilyHistoryDeath",
"Text": "If 'Yes' to death",
"Type": "multi-select",
"AllowNull": false,
"Options": {
"siblings": {
"$id": "138",
"Label": "Sibling(s)",
"SubQuestions": []
},
"1-parent": {
"$id": "139",
"Label": "1 Parent",
"SubQuestions": []
},
"2-parent": {
"$id": "140",
"Label": "2 Parents",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "141",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "142",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "143",
"QuestionId": "CholesterolBloodPressure",
"Text": "Are you currently using, or have you used, any cholesterol lowering medications or been treated for high blood pressure?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "144",
"Label": "Yes",
"SubQuestions": [
{
"$id": "145",
"QuestionId": "CholesterolBloodPressureUnderControl",
"Text": "If 'Yes', is it under control?",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "146",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "147",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "148",
"QuestionId": "CholesterolBloodPressureDuration",
"Text": "How long?",
"Type": "single-select",
"AllowNull": false,
"Options": {
"within-1-year": {
"$id": "149",
"Label": "Within 1 year",
"SubQuestions": []
},
"over-1-year": {
"$id": "150",
"Label": "Over 1 year",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "151",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "152",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "153",
"QuestionId": "UsCitizen",
"Text": "Are you a US citizen?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "154",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "155",
"Label": "No",
"SubQuestions": [
{
"$id": "156",
"QuestionId": "CountryOfCitizenship",
"Text": "Country of citizenship",
"Type": "single-select",
"AllowNull": false,
"Options": {
"Afghanistan": {
"$id": "157",
"Label": "Afghanistan",
"SubQuestions": []
},
"Albania": {
"$id": "158",
"Label": "Albania",
"SubQuestions": []
},
"Algeria": {
"$id": "159",
"Label": "Algeria",
"SubQuestions": []
},
"American Samoa": {
"$id": "160",
"Label": "American Samoa",
"SubQuestions": []
},
"Andorra": {
"$id": "161",
"Label": "Andorra",
"SubQuestions": []
},
"Angola": {
"$id": "162",
"Label": "Angola",
"SubQuestions": []
},
"Anguilla": {
"$id": "163",
"Label": "Anguilla",
"SubQuestions": []
},
"Antarctica": {
"$id": "164",
"Label": "Antarctica",
"SubQuestions": []
},
"Antigua and Barbuda": {
"$id": "165",
"Label": "Antigua and Barbuda",
"SubQuestions": []
},
"Argentina": {
"$id": "166",
"Label": "Argentina",
"SubQuestions": []
},
"Armenia": {
"$id": "167",
"Label": "Armenia",
"SubQuestions": []
},
"Aruba": {
"$id": "168",
"Label": "Aruba",
"SubQuestions": []
},
"Australia": {
"$id": "169",
"Label": "Australia",
"SubQuestions": []
},
"Austria": {
"$id": "170",
"Label": "Austria",
"SubQuestions": []
},
"Azerbaijan": {
"$id": "171",
"Label": "Azerbaijan",
"SubQuestions": []
},
"Bahama": {
"$id": "172",
"Label": "Bahama",
"SubQuestions": []
},
"Bahrain": {
"$id": "173",
"Label": "Bahrain",
"SubQuestions": []
},
"Bangladesh": {
"$id": "174",
"Label": "Bangladesh",
"SubQuestions": []
},
"Barbados": {
"$id": "175",
"Label": "Barbados",
"SubQuestions": []
},
"Belarus": {
"$id": "176",
"Label": "Belarus",
"SubQuestions": []
},
"Belgium": {
"$id": "177",
"Label": "Belgium",
"SubQuestions": []
},
"Belize": {
"$id": "178",
"Label": "Belize",
"SubQuestions": []
},
"Benin": {
"$id": "179",
"Label": "Benin",
"SubQuestions": []
},
"Bermuda": {
"$id": "180",
"Label": "Bermuda",
"SubQuestions": []
},
"Bhutan": {
"$id": "181",
"Label": "Bhutan",
"SubQuestions": []
},
"Bolivia": {
"$id": "182",
"Label": "Bolivia",
"SubQuestions": []
},
"Bosnia and Herzegovina": {
"$id": "183",
"Label": "Bosnia and Herzegovina",
"SubQuestions": []
},
"Botswana": {
"$id": "184",
"Label": "Botswana",
"SubQuestions": []
},
"Bouvet Island": {
"$id": "185",
"Label": "Bouvet Island",
"SubQuestions": []
},
"Brazil": {
"$id": "186",
"Label": "Brazil",
"SubQuestions": []
},
"British Indian Ocean Territory": {
"$id": "187",
"Label": "British Indian Ocean Territory",
"SubQuestions": []
},
"British Virgin Islands": {
"$id": "188",
"Label": "British Virgin Islands",
"SubQuestions": []
},
"Brunei Darussalam": {
"$id": "189",
"Label": "Brunei Darussalam",
"SubQuestions": []
},
"Bulgaria": {
"$id": "190",
"Label": "Bulgaria",
"SubQuestions": []
},
"Burkina Faso": {
"$id": "191",
"Label": "Burkina Faso",
"SubQuestions": []
},
"Burma (no longer exists)": {
"$id": "192",
"Label": "Burma (no longer exists)",
"SubQuestions": []
},
"Burundi": {
"$id": "193",
"Label": "Burundi",
"SubQuestions": []
},
"Côte d'Ivoire (ivory coast)": {
"$id": "194",
"Label": "Côte d'Ivoire (Ivory Coast)",
"SubQuestions": []
},
"Cambodia": {
"$id": "195",
"Label": "Cambodia",
"SubQuestions": []
},
"Cameroon": {
"$id": "196",
"Label": "Cameroon",
"SubQuestions": []
},
"Canada": {
"$id": "197",
"Label": "Canada",
"SubQuestions": []
},
"Cape Verde": {
"$id": "198",
"Label": "Cape Verde",
"SubQuestions": []
},
"Cayman Islands": {
"$id": "199",
"Label": "Cayman Islands",
"SubQuestions": []
},
"Central African Republic": {
"$id": "200",
"Label": "Central African Republic",
"SubQuestions": []
},
"Chad": {
"$id": "201",
"Label": "Chad",
"SubQuestions": []
},
"Chile": {
"$id": "202",
"Label": "Chile",
"SubQuestions": []
},
"China": {
"$id": "203",
"Label": "China",
"SubQuestions": []
},
"Christmas Island": {
"$id": "204",
"Label": "Christmas Island",
"SubQuestions": []
},
"Cocos (Keeling) Islands": {
"$id": "205",
"Label": "Cocos (Keeling) Islands",
"SubQuestions": []
},
"Colombia": {
"$id": "206",
"Label": "Colombia",
"SubQuestions": []
},
"Comoros": {
"$id": "207",
"Label": "Comoros",
"SubQuestions": []
},
"Congo": {
"$id": "208",
"Label": "Congo",
"SubQuestions": []
},
"Cook Islands": {
"$id": "209",
"Label": "Cook Islands",
"SubQuestions": []
},
"Costa Rica": {
"$id": "210",
"Label": "Costa Rica",
"SubQuestions": []
},
"Croatia": {
"$id": "211",
"Label": "Croatia",
"SubQuestions": []
},
"Cuba": {
"$id": "212",
"Label": "Cuba",
"SubQuestions": []
},
"Cyprus": {
"$id": "213",
"Label": "Cyprus",
"SubQuestions": []
},
"Czech Republic": {
"$id": "214",
"Label": "Czech Republic",
"SubQuestions": []
},
"Czechoslovakia (no longer exists)": {
"$id": "215",
"Label": "Czechoslovakia (no longer exists)",
"SubQuestions": []
},
"Democratic Yemen (no longer exists)": {
"$id": "216",
"Label": "Democratic Yemen (no longer exists)",
"SubQuestions": []
},
"Denmark": {
"$id": "217",
"Label": "Denmark",
"SubQuestions": []
},
"Djibouti": {
"$id": "218",
"Label": "Djibouti",
"SubQuestions": []
},
"Dominica": {
"$id": "219",
"Label": "Dominica",
"SubQuestions": []
},
"Dominican republic": {
"$id": "220",
"Label": "Dominican Republic",
"SubQuestions": []
},
"East Timor": {
"$id": "221",
"Label": "East Timor",
"SubQuestions": []
},
"Ecuador": {
"$id": "222",
"Label": "Ecuador",
"SubQuestions": []
},
"Egypt": {
"$id": "223",
"Label": "Egypt",
"SubQuestions": []
},
"El Salvador": {
"$id": "224",
"Label": "El Salvador",
"SubQuestions": []
},
"Equatorial Guinea": {
"$id": "225",
"Label": "Equatorial Guinea",
"SubQuestions": []
},
"Eritrea": {
"$id": "226",
"Label": "Eritrea",
"SubQuestions": []
},
"Estonia": {
"$id": "227",
"Label": "Estonia",
"SubQuestions": []
},
"Ethiopia": {
"$id": "228",
"Label": "Ethiopia",
"SubQuestions": []
},
"Falkland Islands (Malvinas)": {
"$id": "229",
"Label": "Falkland Islands (Malvinas)",
"SubQuestions": []
},
"Faroe Islands": {
"$id": "230",
"Label": "Faroe Islands",
"SubQuestions": []
},
"Fiji": {
"$id": "231",
"Label": "Fiji",
"SubQuestions": []
},
"Finland": {
"$id": "232",
"Label": "Finland",
"SubQuestions": []
},
"France": {
"$id": "233",
"Label": "France",
"SubQuestions": []
},
"France Metropolitan": {
"$id": "234",
"Label": "France Metropolitan",
"SubQuestions": []
},
"French Guiana": {
"$id": "235",
"Label": "French Guiana",
"SubQuestions": []
},
"French Polynesia": {
"$id": "236",
"Label": "French Polynesia",
"SubQuestions": []
},
"French Southern Territories": {
"$id": "237",
"Label": "French Southern Territories",
"SubQuestions": []
},
"Gabon": {
"$id": "238",
"Label": "Gabon",
"SubQuestions": []
},
"Gambia": {
"$id": "239",
"Label": "Gambia",
"SubQuestions": []
},
"Georgia": {
"$id": "240",
"Label": "Georgia",
"SubQuestions": []
},
"German Democratic Republic (no longer exists)": {
"$id": "241",
"Label": "German Democratic Republic (no longer exists)",
"SubQuestions": []
},
"Germany": {
"$id": "242",
"Label": "Germany",
"SubQuestions": []
},
"Ghana": {
"$id": "243",
"Label": "Ghana",
"SubQuestions": []
},
"Gibraltar": {
"$id": "244",
"Label": "Gibraltar",
"SubQuestions": []
},
"Greece": {
"$id": "245",
"Label": "Greece",
"SubQuestions": []
},
"Greenland": {
"$id": "246",
"Label": "Greenland",
"SubQuestions": []
},
"Grenada": {
"$id": "247",
"Label": "Grenada",
"SubQuestions": []
},
"Guadeloupe": {
"$id": "248",
"Label": "Guadeloupe",
"SubQuestions": []
},
"Guam": {
"$id": "249",
"Label": "Guam",
"SubQuestions": []
},
"Guatemala": {
"$id": "250",
"Label": "Guatemala",
"SubQuestions": []
},
"Guinea": {
"$id": "251",
"Label": "Guinea",
"SubQuestions": []
},
"Guinea-bissau": {
"$id": "252",
"Label": "Guinea-Bissau",
"SubQuestions": []
},
"Guyana": {
"$id": "253",
"Label": "Guyana",
"SubQuestions": []
},
"Haiti": {
"$id": "254",
"Label": "Haiti",
"SubQuestions": []
},
"Heard and Mcdonald Islands": {
"$id": "255",
"Label": "Heard and McDonald Islands",
"SubQuestions": []
},
"Honduras": {
"$id": "256",
"Label": "Honduras",
"SubQuestions": []
},
"Hong Kong": {
"$id": "257",
"Label": "Hong Kong",
"SubQuestions": []
},
"Hungary": {
"$id": "258",
"Label": "Hungary",
"SubQuestions": []
},
"Iceland": {
"$id": "259",
"Label": "Iceland",
"SubQuestions": []
},
"India": {
"$id": "260",
"Label": "India",
"SubQuestions": []
},
"Indonesia": {
"$id": "261",
"Label": "Indonesia",
"SubQuestions": []
},
"Iraq": {
"$id": "262",
"Label": "Iraq",
"SubQuestions": []
},
"Ireland": {
"$id": "263",
"Label": "Ireland",
"SubQuestions": []
},
"Islamic Republic of Iran": {
"$id": "264",
"Label": "Islamic Republic of Iran",
"SubQuestions": []
},
"Israel": {
"$id": "265",
"Label": "Israel",
"SubQuestions": []
},
"Italy": {
"$id": "266",
"Label": "Italy",
"SubQuestions": []
},
"Jamaica": {
"$id": "267",
"Label": "Jamaica",
"SubQuestions": []
},
"Japan": {
"$id": "268",
"Label": "Japan",
"SubQuestions": []
},
"Jordan": {
"$id": "269",
"Label": "Jordan",
"SubQuestions": []
},
"Kazakhstan": {
"$id": "270",
"Label": "Kazakhstan",
"SubQuestions": []
},
"Kenya": {
"$id": "271",
"Label": "Kenya",
"SubQuestions": []
},
"Kiribati": {
"$id": "272",
"Label": "Kiribati",
"SubQuestions": []
},
"Korea Democratic People's Republic of": {
"$id": "273",
"Label": "Korea Democratic People's Republic of",
"SubQuestions": []
},
"Korea Republic of": {
"$id": "274",
"Label": "Korea Republic of",
"SubQuestions": []
},
"Kosovo": {
"$id": "275",
"Label": "Kosovo",
"SubQuestions": []
},
"Kuwait": {
"$id": "276",
"Label": "Kuwait",
"SubQuestions": []
},
"Kyrgyzstan": {
"$id": "277",
"Label": "Kyrgyzstan",
"SubQuestions": []
},
"Lao People's Democratic Republic": {
"$id": "278",
"Label": "Lao People's Democratic Republic",
"SubQuestions": []
},
"Latvia": {
"$id": "279",
"Label": "Latvia",
"SubQuestions": []
},
"Lebanon": {
"$id": "280",
"Label": "Lebanon",
"SubQuestions": []
},
"Lesotho": {
"$id": "281",
"Label": "Lesotho",
"SubQuestions": []
},
"Liberia": {
"$id": "282",
"Label": "Liberia",
"SubQuestions": []
},
"Libyan Arab Jamahiriya": {
"$id": "283",
"Label": "Libyan Arab Jamahiriya",
"SubQuestions": []
},
"Liechtenstein": {
"$id": "284",
"Label": "Liechtenstein",
"SubQuestions": []
},
"Lithuania": {
"$id": "285",
"Label": "Lithuania",
"SubQuestions": []
},
"Luxembourg": {
"$id": "286",
"Label": "Luxembourg",
"SubQuestions": []
},
"Macau": {
"$id": "287",
"Label": "Macau",
"SubQuestions": []
},
"Madagascar": {
"$id": "288",
"Label": "Madagascar",
"SubQuestions": []
},
"Malawi": {
"$id": "289",
"Label": "Malawi",
"SubQuestions": []
},
"Malaysia": {
"$id": "290",
"Label": "Malaysia",
"SubQuestions": []
},
"Maldives": {
"$id": "291",
"Label": "Maldives",
"SubQuestions": []
},
"Mali": {
"$id": "292",
"Label": "Mali",
"SubQuestions": []
},
"Malta": {
"$id": "293",
"Label": "Malta",
"SubQuestions": []
},
"Marshall Islands": {
"$id": "294",
"Label": "Marshall Islands",
"SubQuestions": []
},
"Martinique": {
"$id": "295",
"Label": "Martinique",
"SubQuestions": []
},
"Mauritania": {
"$id": "296",
"Label": "Mauritania",
"SubQuestions": []
},
"Mauritius": {
"$id": "297",
"Label": "Mauritius",
"SubQuestions": []
},
"Mayotte": {
"$id": "298",
"Label": "Mayotte",
"SubQuestions": []
},
"Mexico": {
"$id": "299",
"Label": "Mexico",
"SubQuestions": []
},
"Micronesia": {
"$id": "300",
"Label": "Micronesia",
"SubQuestions": []
},
"Moldova Republic of": {
"$id": "301",
"Label": "Moldova Republic of",
"SubQuestions": []
},
"Monaco": {
"$id": "302",
"Label": "Monaco",
"SubQuestions": []
},
"Mongolia": {
"$id": "303",
"Label": "Mongolia",
"SubQuestions": []
},
"Monserrat": {
"$id": "304",
"Label": "Monserrat",
"SubQuestions": []
},
"Morocco": {
"$id": "305",
"Label": "Morocco",
"SubQuestions": []
},
"Mozambique": {
"$id": "306",
"Label": "Mozambique",
"SubQuestions": []
},
"Myanmar": {
"$id": "307",
"Label": "Myanmar",
"SubQuestions": []
},
"Namibia": {
"$id": "308",
"Label": "Namibia",
"SubQuestions": []
},
"Nauru": {
"$id": "309",
"Label": "Nauru",
"SubQuestions": []
},
"Nepal": {
"$id": "310",
"Label": "Nepal",
"SubQuestions": []
},
"Netherlands": {
"$id": "311",
"Label": "Netherlands",
"SubQuestions": []
},
"Netherlands Antilles": {
"$id": "312",
"Label": "Netherlands Antilles",
"SubQuestions": []
},
"Neutral Zone (no longer exists)": {
"$id": "313",
"Label": "Neutral Zone (no longer exists)",
"SubQuestions": []
},
"New Caledonia": {
"$id": "314",
"Label": "New Caledonia",
"SubQuestions": []
},
"New Zealand": {
"$id": "315",
"Label": "New Zealand",
"SubQuestions": []
},
"Nicaragua": {
"$id": "316",
"Label": "Nicaragua",
"SubQuestions": []
},
"Niger": {
"$id": "317",
"Label": "Niger",
"SubQuestions": []
},
"Nigeria": {
"$id": "318",
"Label": "Nigeria",
"SubQuestions": []
},
"Niue": {
"$id": "319",
"Label": "Niue",
"SubQuestions": []
},
"Norfolk Island": {
"$id": "320",
"Label": "Norfolk Island",
"SubQuestions": []
},
"Northern Mariana Islands": {
"$id": "321",
"Label": "Northern Mariana Islands",
"SubQuestions": []
},
"Norway": {
"$id": "322",
"Label": "Norway",
"SubQuestions": []
},
"Oman": {
"$id": "323",
"Label": "Oman",
"SubQuestions": []
},
"Pakistan": {
"$id": "324",
"Label": "Pakistan",
"SubQuestions": []
},
"Palau": {
"$id": "325",
"Label": "Palau",
"SubQuestions": []
},
"Panama": {
"$id": "326",
"Label": "Panama",
"SubQuestions": []
},
"Papua New Guinea": {
"$id": "327",
"Label": "Papua New Guinea",
"SubQuestions": []
},
"Paraguay": {
"$id": "328",
"Label": "Paraguay",
"SubQuestions": []
},
"Peru": {
"$id": "329",
"Label": "Peru",
"SubQuestions": []
},
"Philippines": {
"$id": "330",
"Label": "Philippines",
"SubQuestions": []
},
"Pitcairn": {
"$id": "331",
"Label": "Pitcairn",
"SubQuestions": []
},
"Poland": {
"$id": "332",
"Label": "Poland",
"SubQuestions": []
},
"Portugal": {
"$id": "333",
"Label": "Portugal",
"SubQuestions": []
},
"Puerto Rico": {
"$id": "334",
"Label": "Puerto Rico",
"SubQuestions": []
},
"Qatar": {
"$id": "335",
"Label": "Qatar",
"SubQuestions": []
},
"Réunion": {
"$id": "336",
"Label": "Réunion",
"SubQuestions": []
},
"Romania": {
"$id": "337",
"Label": "Romania",
"SubQuestions": []
},
"Russian Federation": {
"$id": "338",
"Label": "Russian Federation",
"SubQuestions": []
},
"Rwanda": {
"$id": "339",
"Label": "Rwanda",
"SubQuestions": []
},
"Saint Lucia": {
"$id": "340",
"Label": "Saint Lucia",
"SubQuestions": []
},
"Samoa": {
"$id": "341",
"Label": "Samoa",
"SubQuestions": []
},
"San Marino": {
"$id": "342",
"Label": "San Marino",
"SubQuestions": []
},
"Sao Tome and Principe": {
"$id": "343",
"Label": "Sao Tome and Principe",
"SubQuestions": []
},
"Saudi Arabia": {
"$id": "344",
"Label": "Saudi Arabia",
"SubQuestions": []
},
"Senegal": {
"$id": "345",
"Label": "Senegal",
"SubQuestions": []
},
"Serbia": {
"$id": "346",
"Label": "Serbia",
"SubQuestions": []
},
"Seychelles": {
"$id": "347",
"Label": "Seychelles",
"SubQuestions": []
},
"Sierra Leone": {
"$id": "348",
"Label": "Sierra Leone",
"SubQuestions": []
},
"Singapore": {
"$id": "349",
"Label": "Singapore",
"SubQuestions": []
},
"Slovakia": {
"$id": "350",
"Label": "Slovakia",
"SubQuestions": []
},
"Slovenia": {
"$id": "351",
"Label": "Slovenia",
"SubQuestions": []
},
"Solomon Islands": {
"$id": "352",
"Label": "Solomon Islands",
"SubQuestions": []
},
"Somalia": {
"$id": "353",
"Label": "Somalia",
"SubQuestions": []
},
"South Africa": {
"$id": "354",
"Label": "South Africa",
"SubQuestions": []
},
"South Georgia and the South Sandwich Islands": {
"$id": "355",
"Label": "South Georgia and the South Sandwich Islands",
"SubQuestions": []
},
"Spain": {
"$id": "356",
"Label": "Spain",
"SubQuestions": []
},
"Sri Lanka": {
"$id": "357",
"Label": "Sri Lanka",
"SubQuestions": []
},
"St. Helena": {
"$id": "358",
"Label": "St. Helena",
"SubQuestions": []
},
"St. Kitts and Nevis": {
"$id": "359",
"Label": "St. Kitts and Nevis",
"SubQuestions": []
},
"St. Pierre and Miquelon": {
"$id": "360",
"Label": "St. Pierre and Miquelon",
"SubQuestions": []
},
"St. Vincent and the Grenadines": {
"$id": "361",
"Label": "St. Vincent and the Grenadines",
"SubQuestions": []
},
"Sudan": {
"$id": "362",
"Label": "Sudan",
"SubQuestions": []
},
"Suriname": {
"$id": "363",
"Label": "Suriname",
"SubQuestions": []
},
"Svalbard and Jan Mayen Islands": {
"$id": "364",
"Label": "Svalbard and Jan Mayen Islands",
"SubQuestions": []
},
"Swaziland": {
"$id": "365",
"Label": "Swaziland",
"SubQuestions": []
},
"Sweden": {
"$id": "366",
"Label": "Sweden",
"SubQuestions": []
},
"Switzerland": {
"$id": "367",
"Label": "Switzerland",
"SubQuestions": []
},
"Syrian Arab Republic": {
"$id": "368",
"Label": "Syrian Arab Republic",
"SubQuestions": []
},
"Taiwan, Province of China": {
"$id": "369",
"Label": "Taiwan, Province of China",
"SubQuestions": []
},
"Tajikistan": {
"$id": "370",
"Label": "Tajikistan",
"SubQuestions": []
},
"Tanzaniaunited Republic of": {
"$id": "371",
"Label": "Tanzania United Republic of",
"SubQuestions": []
},
"Thailand": {
"$id": "372",
"Label": "Thailand",
"SubQuestions": []
},
"Togo": {
"$id": "373",
"Label": "Togo",
"SubQuestions": []
},
"Tokelau": {
"$id": "374",
"Label": "Tokelau",
"SubQuestions": []
},
"Tonga": {
"$id": "375",
"Label": "Tonga",
"SubQuestions": []
},
"Trinidad and Tobago": {
"$id": "376",
"Label": "Trinidad and Tobago",
"SubQuestions": []
},
"Tunisia": {
"$id": "377",
"Label": "Tunisia",
"SubQuestions": []
},
"Turkey": {
"$id": "378",
"Label": "Turkey",
"SubQuestions": []
},
"Turkmenistan": {
"$id": "379",
"Label": "Turkmenistan",
"SubQuestions": []
},
"Turks and Caicos Islands": {
"$id": "380",
"Label": "Turks and Caicos Islands",
"SubQuestions": []
},
"Tuvalu": {
"$id": "381",
"Label": "Tuvalu",
"SubQuestions": []
},
"Uganda": {
"$id": "382",
"Label": "Uganda",
"SubQuestions": []
},
"Ukraine": {
"$id": "383",
"Label": "Ukraine",
"SubQuestions": []
},
"Union of Soviet Socialist Republics (no longer exists)": {
"$id": "384",
"Label": "Union of Soviet Socialist Republics (no longer exists)",
"SubQuestions": []
},
"United Arab Emirates": {
"$id": "385",
"Label": "United Arab Emirates",
"SubQuestions": []
},
"United Kingdom (Great Britain)": {
"$id": "386",
"Label": "United Kingdom (Great Britain)",
"SubQuestions": []
},
"United States Minor Outlying Oslands": {
"$id": "387",
"Label": "United States Minor Outlying Islands",
"SubQuestions": []
},
"United States of America": {
"$id": "388",
"Label": "United States of America",
"SubQuestions": []
},
"United States Virgin Islands": {
"$id": "389",
"Label": "United States Virgin Islands",
"SubQuestions": []
},
"Unknown or Unspecified Country": {
"$id": "390",
"Label": "Unknown or unspecified country",
"SubQuestions": []
},
"Uruguay": {
"$id": "391",
"Label": "Uruguay",
"SubQuestions": []
},
"Uzbekistan": {
"$id": "392",
"Label": "Uzbekistan",
"SubQuestions": []
},
"Vanuatu": {
"$id": "393",
"Label": "Vanuatu",
"SubQuestions": []
},
"Vatican City State (Holy See)": {
"$id": "394",
"Label": "Vatican City State (Holy See)",
"SubQuestions": []
},
"Venezuela": {
"$id": "395",
"Label": "Venezuela",
"SubQuestions": []
},
"Viet nam": {
"$id": "396",
"Label": "Viet Nam",
"SubQuestions": []
},
"Wallis and Futuna Islands": {
"$id": "397",
"Label": "Wallis and Futuna Islands",
"SubQuestions": []
},
"Western Sahara": {
"$id": "398",
"Label": "Western Sahara",
"SubQuestions": []
},
"Yemen": {
"$id": "399",
"Label": "Yemen",
"SubQuestions": []
},
"Yugoslavia": {
"$id": "400",
"Label": "Yugoslavia",
"SubQuestions": []
},
"Zaire": {
"$id": "401",
"Label": "Zaire",
"SubQuestions": []
},
"Zambia": {
"$id": "402",
"Label": "Zambia",
"SubQuestions": []
},
"Zimbabwe": {
"$id": "403",
"Label": "Zimbabwe",
"SubQuestions": []
}
}
},
{
"$id": "404",
"QuestionId": "UsCitizenVisaType",
"Text": "Visa type",
"Type": "single-select",
"AllowNull": false,
"Options": {
"permanent": {
"$id": "405",
"Label": "Permanent (Green Card)",
"SubQuestions": []
},
"student": {
"$id": "406",
"Label": "Student",
"SubQuestions": []
},
"work": {
"$id": "407",
"Label": "Work",
"SubQuestions": [
{
"$id": "408",
"QuestionId": "UsCitizenVisaTypeWorkYears",
"Text": "Have you been in the United States for more than two years?",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "409",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "410",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "411",
"QuestionId": "UsCitizenVisaTypeWorkRemain",
"Text": "Do you intend to remain in the United States?",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "412",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "413",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "414",
"QuestionId": "UsCitizenVisaTypeWorkHealthcare",
"Text": "Do you have healthcare established in the United States?",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "415",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "416",
"Label": "No",
"SubQuestions": []
}
}
}
]
}
}
}
]
},
"null": {
"$id": "417",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "418",
"QuestionId": "Travel",
"Text": "Have you in the last 3 years, or do you intend to, reside or travel outside the US?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "419",
"Label": "Yes",
"SubQuestions": [
{
"$id": "420",
"QuestionId": "TravelPast",
"Text": "Have you in the last 3 years resided or travelled outside the US? (Not applicable in MA)",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "421",
"Label": "Yes",
"SubQuestions": [
{
"$id": "422",
"QuestionId": "TravelPastWhen1",
"Text": "When?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "423",
"QuestionId": "TravelPastWhere1",
"Text": "Where?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "424",
"QuestionId": "TravelPastDuration1",
"Text": "Duration",
"Type": "single-select",
"AllowNull": false,
"Options": {
"1-3-weeks": {
"$id": "425",
"Label": "1 to 3 weeks",
"SubQuestions": []
},
"1-month": {
"$id": "426",
"Label": "1 month",
"SubQuestions": []
},
"greater-than-2-months": {
"$id": "427",
"Label": "2 to 5 months",
"SubQuestions": []
},
"6-months-or-longer": {
"$id": "428",
"Label": "6 months or longer",
"SubQuestions": []
}
}
},
{
"$id": "429",
"QuestionId": "TravelPastPurpose1",
"Text": "Purpose",
"Type": "single-select",
"AllowNull": false,
"Options": {
"student": {
"$id": "430",
"Label": "Student",
"SubQuestions": []
},
"missionary": {
"$id": "431",
"Label": "Missionary",
"SubQuestions": []
},
"government": {
"$id": "432",
"Label": "Government",
"SubQuestions": []
},
"employer": {
"$id": "433",
"Label": "Employer",
"SubQuestions": []
},
"business": {
"$id": "434",
"Label": "Business",
"SubQuestions": []
},
"pleasure": {
"$id": "435",
"Label": "Pleasure",
"SubQuestions": []
},
"other": {
"$id": "436",
"Label": "Other",
"SubQuestions": []
}
}
},
{
"$id": "437",
"QuestionId": "TravelPastWhen2",
"Text": "When?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "438",
"QuestionId": "TravelPastWhere2",
"Text": "Where?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "439",
"QuestionId": "TravelPastDuration2",
"Text": "Duration",
"Type": "single-select",
"AllowNull": false,
"Options": {
"1-3-weeks": {
"$id": "440",
"Label": "1 to 3 weeks",
"SubQuestions": []
},
"1-month": {
"$id": "441",
"Label": "1 month",
"SubQuestions": []
},
"greater-than-2-months": {
"$id": "442",
"Label": "2 to 5 months",
"SubQuestions": []
},
"6-months-or-longer": {
"$id": "443",
"Label": "6 months or longer",
"SubQuestions": []
}
}
},
{
"$id": "444",
"QuestionId": "TravelPastPurpose2",
"Text": "Purpose",
"Type": "single-select",
"AllowNull": false,
"Options": {
"student": {
"$id": "445",
"Label": "Student",
"SubQuestions": []
},
"missionary": {
"$id": "446",
"Label": "Missionary",
"SubQuestions": []
},
"government": {
"$id": "447",
"Label": "Government",
"SubQuestions": []
},
"employer": {
"$id": "448",
"Label": "Employer",
"SubQuestions": []
},
"business": {
"$id": "449",
"Label": "Business",
"SubQuestions": []
},
"pleasure": {
"$id": "450",
"Label": "Pleasure",
"SubQuestions": []
},
"other": {
"$id": "451",
"Label": "Other",
"SubQuestions": []
}
}
},
{
"$id": "452",
"QuestionId": "TravelPastWhen3",
"Text": "When?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "453",
"QuestionId": "TravelPastWhere3",
"Text": "Where?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "454",
"QuestionId": "TravelPastDuration3",
"Text": "Duration",
"Type": "single-select",
"AllowNull": false,
"Options": {
"1-3-weeks": {
"$id": "455",
"Label": "1 to 3 weeks",
"SubQuestions": []
},
"1-month": {
"$id": "456",
"Label": "1 month",
"SubQuestions": []
},
"greater-than-2-months": {
"$id": "457",
"Label": "2 to 5 months",
"SubQuestions": []
},
"6-months-or-longer": {
"$id": "458",
"Label": "6 months or longer",
"SubQuestions": []
}
}
},
{
"$id": "459",
"QuestionId": "TravelPastPurpose3",
"Text": "Purpose",
"Type": "single-select",
"AllowNull": false,
"Options": {
"student": {
"$id": "460",
"Label": "Student",
"SubQuestions": []
},
"missionary": {
"$id": "461",
"Label": "Missionary",
"SubQuestions": []
},
"government": {
"$id": "462",
"Label": "Government",
"SubQuestions": []
},
"employer": {
"$id": "463",
"Label": "Employer",
"SubQuestions": []
},
"business": {
"$id": "464",
"Label": "Business",
"SubQuestions": []
},
"pleasure": {
"$id": "465",
"Label": "Pleasure",
"SubQuestions": []
},
"other": {
"$id": "466",
"Label": "Other",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "467",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "468",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "469",
"QuestionId": "TravelFuture",
"Text": "Do you intend to reside or travel outside of the United States?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "470",
"Label": "Yes",
"SubQuestions": [
{
"$id": "471",
"QuestionId": "TravelFutureWhen1",
"Text": "When?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "472",
"QuestionId": "TravelFutureWhere1",
"Text": "Where?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "473",
"QuestionId": "TravelFutureDuration1",
"Text": "Duration",
"Type": "single-select",
"AllowNull": false,
"Options": {
"0-2-months": {
"$id": "474",
"Label": "0-2 Months",
"SubQuestions": []
},
"greater-than-2-months": {
"$id": "475",
"Label": "Greater than 2 months",
"SubQuestions": []
}
}
},
{
"$id": "476",
"QuestionId": "TravelFuturePurpose1",
"Text": "Purpose",
"Type": "single-select",
"AllowNull": false,
"Options": {
"student": {
"$id": "477",
"Label": "Student",
"SubQuestions": []
},
"missionary": {
"$id": "478",
"Label": "Missionary",
"SubQuestions": []
},
"government": {
"$id": "479",
"Label": "Government",
"SubQuestions": []
},
"employer": {
"$id": "480",
"Label": "Employer",
"SubQuestions": []
},
"business": {
"$id": "481",
"Label": "Business",
"SubQuestions": []
},
"pleasure": {
"$id": "482",
"Label": "Pleasure",
"SubQuestions": []
},
"other": {
"$id": "483",
"Label": "Other",
"SubQuestions": []
}
}
},
{
"$id": "484",
"QuestionId": "TravelFutureWorkEnvironment1",
"Text": "Anticipated Work Environment",
"Type": "single-select",
"AllowNull": false,
"Options": {
"metropolitan-area": {
"$id": "485",
"Label": "Metropolitan Area",
"SubQuestions": []
},
"rural-area": {
"$id": "486",
"Label": "Rural/Agricultural Area",
"SubQuestions": []
},
"primitive-area": {
"$id": "487",
"Label": "Primitive/Native Area",
"SubQuestions": []
}
}
},
{
"$id": "488",
"QuestionId": "TravelFutureCurrentOccupation1",
"Text": "Current Occupation",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "489",
"QuestionId": "TravelFutureCurrentDuties1",
"Text": "Duties",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "490",
"QuestionId": "TravelFutureWhen2",
"Text": "When?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "491",
"QuestionId": "TravelFutureWhere2",
"Text": "Where?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "492",
"QuestionId": "TravelFutureDuration2",
"Text": "Duration",
"Type": "single-select",
"AllowNull": false,
"Options": {
"0-2-months": {
"$id": "493",
"Label": "0-2 Months",
"SubQuestions": []
},
"greater-than-2-months": {
"$id": "494",
"Label": "Greater than 2 months",
"SubQuestions": []
}
}
},
{
"$id": "495",
"QuestionId": "TravelFuturePurpose2",
"Text": "Purpose",
"Type": "single-select",
"AllowNull": false,
"Options": {
"student": {
"$id": "496",
"Label": "Student",
"SubQuestions": []
},
"missionary": {
"$id": "497",
"Label": "Missionary",
"SubQuestions": []
},
"government": {
"$id": "498",
"Label": "Government",
"SubQuestions": []
},
"employer": {
"$id": "499",
"Label": "Employer",
"SubQuestions": []
},
"business": {
"$id": "500",
"Label": "Business",
"SubQuestions": []
},
"pleasure": {
"$id": "501",
"Label": "Pleasure",
"SubQuestions": []
},
"other": {
"$id": "502",
"Label": "Other",
"SubQuestions": []
}
}
},
{
"$id": "503",
"QuestionId": "TravelFutureWorkEnvironment2",
"Text": "Anticipated Work Environment",
"Type": "single-select",
"AllowNull": false,
"Options": {
"metropolitan-area": {
"$id": "504",
"Label": "Metropolitan Area",
"SubQuestions": []
},
"rural-area": {
"$id": "505",
"Label": "Rural/Agricultural Area",
"SubQuestions": []
},
"primitive-area": {
"$id": "506",
"Label": "Primitive/Native Area",
"SubQuestions": []
}
}
},
{
"$id": "507",
"QuestionId": "TravelFutureCurrentOccupation2",
"Text": "Current Occupation",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "508",
"QuestionId": "TravelFutureCurrentDuties2",
"Text": "Duties",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "509",
"QuestionId": "TravelFutureWhen3",
"Text": "When?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "510",
"QuestionId": "TravelFutureWhere3",
"Text": "Where?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "511",
"QuestionId": "TravelFutureDuration3",
"Text": "Duration",
"Type": "single-select",
"AllowNull": false,
"Options": {
"0-2-months": {
"$id": "512",
"Label": "0-2 Months",
"SubQuestions": []
},
"greater-than-2-months": {
"$id": "513",
"Label": "Greater than 2 months",
"SubQuestions": []
}
}
},
{
"$id": "514",
"QuestionId": "TravelFuturePurpose3",
"Text": "Purpose",
"Type": "single-select",
"AllowNull": false,
"Options": {
"student": {
"$id": "515",
"Label": "Student",
"SubQuestions": []
},
"missionary": {
"$id": "516",
"Label": "Missionary",
"SubQuestions": []
},
"government": {
"$id": "517",
"Label": "Government",
"SubQuestions": []
},
"employer": {
"$id": "518",
"Label": "Employer",
"SubQuestions": []
},
"business": {
"$id": "519",
"Label": "Business",
"SubQuestions": []
},
"pleasure": {
"$id": "520",
"Label": "Pleasure",
"SubQuestions": []
},
"other": {
"$id": "521",
"Label": "Other",
"SubQuestions": []
}
}
},
{
"$id": "522",
"QuestionId": "TravelFutureWorkEnvironment3",
"Text": "Anticipated Work Environment",
"Type": "single-select",
"AllowNull": false,
"Options": {
"metropolitan-area": {
"$id": "523",
"Label": "Metropolitan Area",
"SubQuestions": []
},
"rural-area": {
"$id": "524",
"Label": "Rural/Agricultural Area",
"SubQuestions": []
},
"primitive-area": {
"$id": "525",
"Label": "Primitive/Native Area",
"SubQuestions": []
}
}
},
{
"$id": "526",
"QuestionId": "TravelFutureCurrentOccupation3",
"Text": "Current Occupation",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "527",
"QuestionId": "TravelFutureCurrentDuties3",
"Text": "Duties",
"Type": "text",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "528",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "529",
"Label": "?",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "530",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "531",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "532",
"QuestionId": "MovingViolations",
"Text": "In the last 3 years, have you received any moving violations?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "533",
"Label": "Yes",
"SubQuestions": [
{
"$id": "534",
"QuestionId": "MovingViolationsNumber",
"Text": "If 'Yes', indicate number",
"Type": "single-select",
"AllowNull": false,
"Options": {
"1": {
"$id": "535",
"Label": "1",
"SubQuestions": []
},
"2": {
"$id": "536",
"Label": "2",
"SubQuestions": []
},
"3": {
"$id": "537",
"Label": "3",
"SubQuestions": []
},
"4-or-more": {
"$id": "538",
"Label": "4 or more",
"SubQuestions": []
}
}
}
]
},
"false": {
"$id": "539",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "540",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "541",
"QuestionId": "DUI",
"Text": "Have you ever been convicted of reckless driving, driving to endanger or driving under the influence of drugs or alcohol or has your driver's license been suspended or revoked?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "542",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "543",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "544",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "545",
"QuestionId": "Conviction",
"Text": "Except for traffic violations, have you been the subject of, or been convicted of, a misdemeanor or felony, or are you awaiting trial for a felony?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "546",
"Label": "Yes",
"SubQuestions": [
{
"$id": "547",
"QuestionId": "ConvictionDetails",
"Text": "If 'Yes', please provide details",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "548",
"QuestionId": "ConvictionProbation",
"Text": "Are you on probation?",
"Type": "boolean",
"AllowNull": false,
"Options": {}
}
]
},
"false": {
"$id": "549",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "550",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "551",
"QuestionId": "LifestyleActivities",
"Text": "Have you in the last 3 years engaged in, or do you intend to engage in, flying a plane, racing motor boats or motor vehicles, or participate in sky-diving or parachuting, hang gliding, hot air ballooning, mountain, rock or ice climbing, scuba diving or hazardous activities?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "552",
"Label": "Yes",
"SubQuestions": [
{
"$id": "553",
"QuestionId": "HazardousActivitiesFlyingPlane",
"Text": "Flying a Plane",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "554",
"Label": "Yes",
"SubQuestions": [
{
"$id": "555",
"QuestionId": "HazardousActivitiesFlyingPlanePastHours",
"Text": "If 'Yes' to Flying a Plane, total number of hours flown as pilot in past 12 months",
"Type": "number",
"AllowNull": false,
"Options": {
"true": {
"$id": "556",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "557",
"Label": "No",
"SubQuestions": []
}
}
},
{
"$id": "558",
"QuestionId": "HazardousActivitiesFlyingPlaneFutureHours",
"Text": "Estimate number of hours in next 12 months",
"Type": "number",
"AllowNull": false,
"Options": {}
},
{
"$id": "559",
"QuestionId": "HazardousActivitiesFlyingPlaneCertification",
"Text": "Pilot certification held?",
"Type": "single-select",
"AllowNull": false,
"Options": {
"student": {
"$id": "560",
"Label": "Student",
"SubQuestions": []
},
"private": {
"$id": "561",
"Label": "Private",
"SubQuestions": []
},
"commercial": {
"$id": "562",
"Label": "Commercial",
"SubQuestions": []
}
}
},
{
"$id": "563",
"QuestionId": "HazardousActivitiesFlyingPlaneCertificationDate",
"Text": "Date of Issue",
"Type": "date",
"AllowNull": false,
"Options": {}
}
]
}
}
},
{
"$id": "564",
"QuestionId": "HazardousActivitiesVehicleRacing",
"Text": "Motor Vehicle or Boat Racing",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "565",
"QuestionId": "HazardousActivitiesSkyDiving",
"Text": "Sky Diving or Parachuting",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "566",
"QuestionId": "HazardousActivitiesHangGliding",
"Text": "Hang Gliding",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "567",
"QuestionId": "HazardousActivitiesBallooning",
"Text": "Hot Air Ballooning",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "568",
"QuestionId": "HazardousActivitiesClimbing",
"Text": "Mountain, Rock or Ice Climbing",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "569",
"QuestionId": "HazardousActivitiesScubaDiving",
"Text": "Scuba Diving",
"Type": "boolean",
"AllowNull": false,
"Options": {
"true": {
"$id": "570",
"Label": "Yes",
"SubQuestions": [
{
"$id": "571",
"QuestionId": "HazardousActivitiesScubaDivingDepth",
"Text": "If 'Yes' to Scuba Diving, depth?",
"Type": "single-select",
"AllowNull": false,
"Options": {
"to-75-feet": {
"$id": "572",
"Label": "To 75 Feet",
"SubQuestions": []
},
"76-to-100-feet": {
"$id": "573",
"Label": "Between 76 and 100 Feet",
"SubQuestions": []
},
"below-100-feet": {
"$id": "574",
"Label": "Below 100 Feet",
"SubQuestions": []
}
}
},
{
"$id": "575",
"QuestionId": "HazardousActivitiesScubaDivingNumberDives",
"Text": "Number of Dives?",
"Type": "number",
"AllowNull": false,
"Options": {}
},
{
"$id": "576",
"QuestionId": "HazardousActivitiesScubaDivingTimePerDive",
"Text": "Average Time per Dive?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "577",
"QuestionId": "HazardousActivitiesScubaDivingNumberFutureDives",
"Text": "Next 36 Months - Number of Expected Dives?",
"Type": "number",
"AllowNull": false,
"Options": {}
},
{
"$id": "578",
"QuestionId": "HazardousActivitiesScubaDivingEquipmentType",
"Text": "What type of equipment do you use?",
"Type": "text",
"AllowNull": false,
"Options": {}
},
{
"$id": "579",
"QuestionId": "HazardousActivitiesScubaDivingLocations",
"Text": "What are the locations of your dives? Indicate all that apply",
"Type": "multi-select",
"AllowNull": false,
"Options": {
"cave": {
"$id": "580",
"Label": "Cave",
"SubQuestions": []
},
"wreck": {
"$id": "581",
"Label": "Wreck",
"SubQuestions": []
},
"under-ice": {
"$id": "582",
"Label": "Under Ice",
"SubQuestions": []
},
"treasure-expedition": {
"$id": "583",
"Label": "Treasure/Expedition",
"SubQuestions": []
},
"ocean": {
"$id": "584",
"Label": "Ocean",
"SubQuestions": []
},
"rescue": {
"$id": "585",
"Label": "Rescue",
"SubQuestions": []
}
}
},
{
"$id": "586",
"QuestionId": "HazardousActivitiesScubaDivingCertified",
"Text": "Are you currently certified by one of the national training & certification programs?",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "587",
"QuestionId": "HazardousActivitiesScubaDivingMemberClub",
"Text": "Are you a member of an organized club?",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "588",
"QuestionId": "HazardousActivitiesScubaDivingDiveAlone",
"Text": "Do you ever dive alone?",
"Type": "boolean",
"AllowNull": false,
"Options": {}
},
{
"$id": "589",
"QuestionId": "HazardousActivitiesScubaDivingForCompensation",
"Text": "Do you now dive or contemplate diving for compensation?",
"Type": "boolean",
"AllowNull": false,
"Options": {}
}
]
}
}
}
]
},
"false": {
"$id": "590",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "591",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "592",
"QuestionId": "ArmedServices",
"Text": "Are you currently or intend to become, a member of the Armed Forces, including the Reserves or National Guard?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "593",
"Label": "Yes",
"SubQuestions": []
},
"false": {
"$id": "594",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "595",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "596",
"QuestionId": "Medications",
"Text": "Are you now taking, or have you been advised to take any medications?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "597",
"Label": "Yes",
"SubQuestions": [
{
"$id": "598",
"QuestionId": "MedicationsDetails",
"Text": "If 'Yes', please explain",
"Type": "text",
"AllowNull": true,
"Options": {}
}
]
},
"false": {
"$id": "599",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "600",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "601",
"QuestionId": "Procedures",
"Text": "In the past 12 months have you had or have you scheduled in the next 12 months - surgery, or medical tests (mammogram, colonoscopy, MRI, etc)?",
"Type": "boolean",
"AllowNull": true,
"Options": {
"true": {
"$id": "602",
"Label": "Yes",
"SubQuestions": [
{
"$id": "603",
"QuestionId": "ProceduresDetails",
"Text": "If 'Yes', please explain",
"Type": "text",
"AllowNull": true,
"Options": {}
}
]
},
"false": {
"$id": "604",
"Label": "No",
"SubQuestions": []
},
"null": {
"$id": "605",
"Label": "?",
"SubQuestions": []
}
}
},
{
"$id": "606",
"QuestionId": "AdditionalInformation",
"Text": "Please use the section below to explain any questions to which you answered 'Yes' and provide any additional information",
"Type": "text-long",
"AllowNull": true,
"Options": {}
}
]